Impact of the COVID-19 pandemic on patients with advanced chronic kidney disease: an epidemiological, clinical and psychosocial perspective

This thesis examines how the COVID-19 pandemic affected people with advanced kidney disease, including dialysis patients and kidney transplant recipients. These patients were at high risk of severe illness and often had weaker responses to vaccination.
Using national and international registry and cohort studies, we explored how frailty influenced intensive care decisions and outcomes, finding that frail dialysis patients were less often admitted to the ICU and had higher mortality rates. We also studied vaccine responses, showing that immunosuppressive treatments lowered antibody responses, especially in kidney transplant recipients, which in turn was associated the risk of post COVID-19 condition.
Finally, we analysed the health-related quality of life of dialysis patients throughout the pandemic, considering COVID-19 diagnosis, vaccination status, and public health measures.
Together, these findings provide evidence to guide vaccination strategies, clinical care, and public health decisions, helping to protect vulnerable kidney patients during current and future health crises.