Introduction and aim. Long-term outcomes of COVID-19 pose a global challenge, particularly impacting individuals with un derlying health conditions, including those who have undergone hemodialysis (HD). The study aimed to investigate the rela tionship between preexisting dialysis dose, measured by single pool Kt/V (spKt/V), and long-term outcomes of COVID-19 in patients undergoing HD. Material and methods. Demographic, clinical, and laboratory parameters following COVID-19 recovery, and long-term out comes, including the presence of COVID-19 sequelae, hospitalization, and all-cause mortality during a year after COVID-19 were retrospectively analyzed. Results. Out of the 195 patients included, there were 108 males (55.4%) and 87 females (44.6%), with a median age of 56 (44-63) years and a dialysis duration of 49 (31.3–85.2) months. Patients with spKt/V<1.4 had a significantly increased risk of long-term COVID-19 sequelae (HR 9.1, 95% CI: 3.4; 24.6), hospitalization (HR 7.6, 95% CI: 3.9; 14.6), and all-cause mortality (HR 8.5, 95% CI: 2.9; 25.8) within one year after COVID-19 recovery compared with those with spKt/V≥1.4. spKt/V cutoff point of ≤1.3 emerged as a significant risk factor for one-year hospitalization and mortality within our cohort. Conclusion. Suboptimal dialysis dose, as indicated by spKt/V < 1.4, is associated with adverse long-term COVID-19 outcomes in patients undergoing HD. Optimizing dialysis adequacy may mitigate these risks. Further research is needed to validate these f indings and explore interventions to improve outcomes in this vulnerable population.