Long‐lasting clinical symptoms 6 months after COVID-19 infection in the French national cohort of patients on dialysis

Abstract

Background Systematic reviews have shown a high prevalence of long-term persistent sequelae after COVID-19. The aim of this study was to describe the prevalence and risk factors associated with long‐lasting clinical symptoms (LLCS) in survivors on chronic dialysis at 6 months after the onset of acute COVID-19 infection in the pre-vaccination period. Methods This national cohort study included all French patients on dialysis who had SARS-Cov-2 infection between March and December 2020 and who were alive and still on dialysis 6 months after infection. A form was filled in at 6 months concerning the presence of the following persistent symptoms: extreme fatigue, headache, muscle or weight loss of > 5%, respiratory sequelae, tachycardia, chest pain, joint or muscle pain, persistent anosmia or ageusia, diarrhea, sensory disorders, neuro-cognitive disorders, post-traumatic stress syndrome, depression, and anxiety. Results Complete survey results were available for 1217 patients (25.2% of those included); 216 (17.7%) had some LLCS. Probability of 6-month LLCS was higher in patients who were hospitalized in a medical or intensive care unit: OR 1.64 (95% CI 1.16–2.33) and 5.03 (2.94–8.61), respectively. Younger patients had a lower probability of LLCS. Each year on dialysis, as well as diabetes, overweight or obesity were associated with a higher probability of LLCS by 1.03 (1.01–1.06), 1.53 (1.08–2.17), 1.96 (1.10–3.52) and 2.35 (1.30–4.26), respectively. Conclusions This national study shows that at least one in six patients on dialysis who have COVID-19 will have LLCS. Systematic screening in dialysis patients would allow us to identify those who need more careful prevention and long-term care and to address them towards a rehabilitation pathway.

A Systematic Review of the Prevalence of Persistent Gastrointestinal Symptoms and Incidence of New Gastrointestinal Illness after Acute SARS-CoV-2 Infection

“…The studies were conducted from early 2020 to mid-2023 in twenty-eight different countries across Europe, the Americas, Africa and Asia ( Table 2 and Table 3 ). Forty-one studies were sourced from peer-review journals [ 8 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 ]. Four studies were pre-print and were awaiting peer review at the time of writing [ 70 , 71 , 72 , 73 ].…”

“…Three studies included patients with COVID-19 pneumonia diagnosed through a computerised tomography (CT) scan in addition to those diagnosed via RT-PCR [ 34 , 35 , 36 ]. Two included those diagnosed with clinical symptoms in addition to those diagnosed via RT-PCR and CT scan, but this formed a small percentage of the overall cohort (4% and 16%) [ 31 , 37 ]. One study included participants with COVID-19 illness diagnosed based on clinical history and examination by a physician, in addition to those with laboratory-confirmed SARS-CoV-2 infection [ 38 ].…”

“…The studies also varied in their clinical settings and ascertainment of gastrointestinal symptoms. Fourteen studies were conducted on patients who were hospitalised with COVID-19, discharged and followed up in the community [ 33 , 34 , 35 , 41 , 42 , 43 , 44 , 45 , 57 , 60 , 62 , 63 , 67 , 71 ], twenty-one studies involved both hospitalised and community-managed cases [ 8 , 30 , 32 , 36 , 37 , 40 , 46 , 47 , 48 , 49 , 50 , 55 , 59 , 61 , 64 , 65 , 66 , 68 , 69 , 70 , 72 ], seven studies involved community cases that did not require hospital admission [ 38 , 39 , 51 , 52 , 53 , 56 , 58 ] and three studies did not specify the setting of recruitment [ 31 , 54 , 73 ].…”

“…Most studies ( n = 27) measured gastrointestinal outcomes using a survey or questionnaire administered via telephone or electronically [ 30 , 31 , 32 , 36 , 37 , 38 , 39 , 40 , 45 , 46 , 47 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 61 , 63 , 65 , 70 , 71 ]. Seven studies used EHRs to identify gastrointestinal endpoints based on clinical codes [ 8 , 60 , 66 , 67 , 69 , 72 , 73 ].…”

“…The risk of having persisting clinical symptoms at six months was higher in patients who were hospitalised with moderate to severe disease (1.64 times) and those requiring intensive care treatment (5.03 times). Older age and longer duration of dialysis were also found to increase the risk of persistent symptoms [ 37 ]. Another study on RRT and kidney transplant patients conducted in Thailand reported the prevalence of anorexia and abdominal pain at 90.9% and 62.5%, respectively, after three months.…”