COVID-19 in End-Stage Renal Disease, Does It Differ? Multicentre, Retrospective Study

Background: Patients with end-stage renal disease (ESRD) are highly liable to COVID-19 and are liable for its severe complications. Assessment of the infection of covid-19 in this special group of population is mandatory in their medical follow up strategies. Methods: In this multicenter retrospective cohort study (February to may2023, Menoufia, Egypt), 57 ESRD patients on maintenance hemodialysis with confirmed COVID-19 were compared with 482non-ESRD COVID-19 patients from general population. Clinical data and outcomes were collected and analyzed.  Odds ratio (ORs) with 95% confidence intervals (CIs) were calculated.
Results: ESRD patients reported fewer typical symptoms, including fever (38.6% vs. 73.9, p < 0.001) and cough (10.5% vs. 67.8%, p < 0.001). However, outcomes were significantly worse: intensive care unit (ICU) admission was over fourfold higher (31.6% vs. 6.8%; RR 4.64, 95% CI 2.55–8.44), mortality nearly doubled (26.3% vs. 15.1%; RR 1.74, 95% CI 1.02–2.96), and post-COVID thrombosis tripled (8.8% vs. 2.7%; RR 3.24, 95% CI 1.10–9.55). Adverse events after CoronaVac vaccination were less frequent in ESRD patients, including injection-site pain (26.3% vs. 42.3%, p = 0.020) and fatigue (12.3% vs. 25.9%, p = 0.023). Conclusion: ESRD patients with COVID-19 present atypically but suffer more severe outcomes, including higher ICU admission, mortality, and thrombosis. Vaccination was well tolerated, though reduced reactogenicity may reflect blunted immune responses. These findings highlight the need for early testing, close monitoring, and optimized vaccination strategies in dialysis populations.