#1149 Long-COVID in hemodialysis patients: a matched case-control prospective study
Authors: Han Maggie , Wang Lin-Chun , Ren Sarah , Tisdale Lela , Dong Zijun , Nze Chidiadi , Thwin Ohnmar , Kotanko Peter 
Published: May 2024

Abstract

Background and Aims
Long-COVID is defined as persistent symptoms after COVID-19 infection. It has been reported that up to 40% of COVID-19 survivors experience long-COVID (O'Mahoney et al. The Lancet, 2023). We aim to determine if hemodialysis (HD) patients experience long-COVID.

Method
HD patients diagnosed with COVID-19 via RT-PCR test were enrolled from January to April 2022 from 4 clinics in New York City. COVID-19 Yorkshire Rehabilitation Scale (C19-YRS) was administered at baseline (i.e., as soon as possible after diagnosis), and 1 and 6 months after baseline. C19-YRS measures symptoms such as dyspnea, fatigue, decreased cognition, etc. before and after COVID-19 infection. Pre-COVID symptom severity at baseline was used as the comparator when determining differences between pre- and post-COVID periods. Controls were also enrolled as symptoms resembling long-COVID symptoms are prevalent in HD patients who did not have COVID-19 (e.g., fatigue, lowered quality of life, cognitive impairment). Controls were matched to case patients by age (&lt;50 years, 50-70 years, &gt;70 years), vintage (&lt;1 year, 1-5 years, &gt;5 years), sex, and race. In control patients, a modified C19-YRS that excluded questions specifically around COVID-19 infection was administered at the time of enrollment, and 1 and 6 months thereafter. Symptom severity is graded from 0-10 (10 being the worst) and global health score is reported with 10 being the best. Patient demographic and clinical data were obtained from medical records. Paired t-tests tests were used to examine differences in symptom severity pre- and post-COVID-19 infection in case patients. Unpaired t-tests or Chi-squared tests were used to examine differences at each time point in cases and controls. Linear and generalized mixed models were used to examine the effect of time on continuous and discrete long-COVID symptom severity, respectively.

Results
We studied 30 patients, 15 cases and 15 controls. There were no significant differences between the two groups in age, vintage, sex, race, ethnicity, diabetes, or hypertension (Table 1a). Baseline C19-YRS was administered 43 ± 24 days (range 9-108) after COVID-19 diagnosis. Five patients were hospitalized because of COVID-19 infection. C19-YRS results are shown in Table 1b. Compared to the pre-COVID period, case patients experienced significantly increased dyspnea at baseline; anxiety, depression, and dyspnea at 1 month; fatigue and dyspnea at 6 months. Further, fatigue and ability to perform personal care worsened in case patients from baseline to 6 months. Compared to the cases, controls had significantly higher global health scores at 1 month and a lower prevalence of dyspnea at rest and fatigue at 6 months.

Conclusion
Following COVID-19 infection, patients report worsening long-COVID symptoms compared to (a) the pre-COVID period and (b) matched controls, specifically fatigue, dyspnea at rest, and decreased perceived health. Further studies are warranted to investigate the long-term consequences of long-COVID in HD patients.