Hostname: page-component-77f85d65b8-grvzd Total loading time: 0 Render date: 2026-04-14T05:36:57.159Z Has data issue: false hasContentIssue false
  • English
  • Français

SARS-CoV-2 infection rates among home dialysis patients and patients receiving hemodialysis at outpatient centers, January 2021–May 2023, United States

Published online by Cambridge University Press:  07 January 2026

Austin Woods Open the ORCID record for Austin Woods [Opens in a new window] ,
Jose Navarrete Open the ORCID record for Jose Navarrete [Opens in a new window] ,
Qunna Li Open the ORCID record for Qunna Li [Opens in a new window] ,
Kira Barbre Open the ORCID record for Kira Barbre [Opens in a new window] ,
Lu Meng Open the ORCID record for Lu Meng [Opens in a new window] ,
Gregory Barone ,
Leticia Lamping Open the ORCID record for Leticia Lamping [Opens in a new window] ,
Ryan Wiegand Open the ORCID record for Ryan Wiegand [Opens in a new window] ,
Shannon Novosad Open the ORCID record for Shannon Novosad [Opens in a new window]  and
Andrea Benin Open the ORCID record for Andrea Benin [Opens in a new window]
...Show all authors
Austin Woods*
Affiliation:
Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA Chenega Enterprise Systems & Solutions, LLC, Chesapeake, VA, USA
Jose Navarrete
Affiliation:
Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA Renal Division, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
Qunna Li
Affiliation:
Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
Kira Barbre
Affiliation:
Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA Goldbelt C6, Chesapeake, VA, USA
Lu Meng
Affiliation:
Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
Gregory Barone
Affiliation:
Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
Leticia Lamping
Affiliation:
Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA Chenega Enterprise Systems & Solutions, LLC, Chesapeake, VA, USA
Ryan Wiegand
Affiliation:
Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
Shannon Novosad
Affiliation:
Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
Andrea Benin
Affiliation:
Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
Jonathan Edwards
Affiliation:
Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
Jeneita Bell
Affiliation:
Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
*
Corresponding author: Austin Woods; Email: qsh2@cdc.gov
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To assess differences in SARS-CoV-2 infection rates between patients receiving hemodialysis in outpatient centers (in-center) and those receiving dialysis in their homes (hemodialysis and peritoneal dialysis) from December 29, 2020, through May 9, 2023.

Design:

Retrospective cohort study.

Setting:

Outpatient dialysis facilities in the United States reporting to the Centers for Disease Control and Prevention’s National Healthcare Safety Network.

Patients:

Maintenance dialysis patients that received hemodialysis treatment at or were affiliated with outpatient dialysis facilities.

Methods:

SARS-CoV-2 infection rates were assessed by dialysis setting (in-center and home). Weeks were categorized as surge (rate of infection > median) and non-surge (rate of infection ≤ median) and by variant predominance. A negative binomial regression model with generalized estimating equations was constructed to examine differences in rates of infection among patients.

Results:

A total of 7,974 dialysis facilities reported 171,338 SARS-CoV-2 infections among patients. In-center hemodialysis patients had higher average rates of SARS-CoV-2 infection at 2.85 infections per 1000 patient-weeks than home patients at 1.69 infections per 1000 patient-weeks. During surge weeks, the differences in rates of infection between in-center and home patients were more pronounced than during non-surge weeks for all variant predominance categories: Delta (relative rate ratio (RRR) = 1.20, CI: 1.09–1.32), B.1 and Other (RRR = 1.11, CI: 1.02–1.22), and Omicron (RRR = 1.07, CI: 1.01–1.12).

Conclusion:

Rates of SARS-CoV-2 infection among patients receiving outpatient hemodialysis were persistently higher than rates among patients receiving dialysis treatments at home; these differences were more pronounced during surge weeks.

Information

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 47 , Issue 3 , March 2026 , pp. 290 - 294
Check for updates
Creative Commons
This is a work of the US Government and is not subject to copyright protection within the United States. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America.
Copyright
© Centers for Disease Control and Prevention, 2026

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

Williamson, EJ, Walker, AJ, Bhaskaran, K, Bacon, S, Bates, C, Morton, CE, et al. Factors associated with COVID-19-related death using OpenSAFELY. Nature 2020;584:430–436.CrossRefGoogle ScholarPubMed
Weiss, A, Hendrickx, R, Stensgaard, E, Jellingsø, M, Sommer, MOA. Kidney transplant and dialysis patients remain at increased risk for succumbing to COVID-19. Transplantation 2023;107:1136–1138.CrossRefGoogle ScholarPubMed
Hsu, CM, Weiner, DE, Aweh, G, Miskulin, DC, Manley, HJ, Stewart, C, et al. COVID-19 among US dialysis patients: risk factors and outcomes from a national dialysis provider. Am J Kidney Dis 2021;77:748–56.e1.CrossRefGoogle ScholarPubMed
Navarrete, J, Barone, G, Qureshi, I, Woods, A, Barbre, K, Meng, L, et al. SARS-CoV-2 infection and death rates among maintenance dialysis patients during delta and early omicron waves - United States, June 30, 2021-September 27, 2022. MMWR Morb Mortal Wkly Rep 2023;72:871–876.CrossRefGoogle ScholarPubMed
Salerno, S, Messana, JM, Gremel, GW, Dahlerus, C, Hirth, RA, Han, P, et al. COVID-19 risk factors and mortality outcomes among Medicare patients receiving long-term dialysis. JAMA Netw Open 2021;4:e2135379.CrossRefGoogle ScholarPubMed
Yau, K, Muller, MP, Lin, M, Siddiqui, N, Neskovic, S, Shokar, G, et al. COVID-19 outbreak in an urban hemodialysis unit. Am J Kidney Dis 2020;76:690–5.e1.CrossRefGoogle Scholar
Ikizler, TA. COVID-19 and dialysis units: what do we know now and what should we do? Am J Kidney Dis 2020;76:1–3.CrossRefGoogle Scholar
Karen, L, Tritz, DRW. Guidance for the Expiration of the COVID-19 Public Health Emergency (PHE). In: Center for Clinical Standards and Quality/Quality SOG, editor. Baltimore, Maryland 2023.Google Scholar
Topf, KG, Sheppard, M, Marx, GE, Wiegand, RE, Link-Gelles, R, Binder, AM, et al. Impact of the COVID-19 vaccination program on case incidence, emergency department visits, and hospital admissions among children aged 5–17 Years during the delta and omicron periods—United States, December 2020 to April 2022. PLOS ONE 2022;17:e0276409.CrossRefGoogle ScholarPubMed
Ma, KC, Shirk, P, Lambrou, AS, Hassell, N, Zheng, XY, Payne, AB, et al. Genomic surveillance for SARS-CoV-2 variants: circulation of omicron lineages – United States, January 2022–May 2023. MMWR Morb Mortal Wkly Rep 2023;72:651–656.CrossRefGoogle ScholarPubMed
Lambrou, AS, Shirk, P, Steele, MK, Paul, P, Paden, CR, Cadwell, B, et al. Genomic surveillance for SARS-CoV-2 variants: predominance of the delta (B.1.617.2) and omicron (B.1.1.529) Variants – United States, June 2021–January 2022. MMWR Morb Mortal Wkly Rep 2022;71:206–211.CrossRefGoogle ScholarPubMed
Perl, J, Thomas, D, Tang, Y, Yeung, A, Ip, J, Oliver, MJ, et al. COVID-19 among adults receiving home versus in-center dialysis. Clin J Am Soc Nephrol 2021;16:1410–1412.CrossRefGoogle ScholarPubMed
Rostoker, G, Issad, B, Fessi, H, Massy, ZA. Why and how should we promote home dialysis for patients with end-stage kidney disease during and after the coronavirus 2019 disease pandemic? A French perspective. J Nephrol 2021;34:985–989.CrossRefGoogle ScholarPubMed
Quintaliani, G, Reboldi, G, Di Napoli, A, Nordio, M, Limido, A, Aucella, F, et al. Exposure to novel coronavirus in patients on renal replacement therapy during the exponential phase of COVID-19 pandemic: survey of the Italian society of nephrology. J Nephrol 2020;33:725–736.CrossRefGoogle ScholarPubMed
Corbett, RW. Home dialysis therapies. Clin Med (Lond) 2023;23:259–261.CrossRefGoogle ScholarPubMed
Silberzweig, J, Kliger, AS. 54 - COVID-19 and dialysis patients. In: Nissenson, AR, Fine, RN, Mehrotra, R, Zaritsky, J, editors. Handbook of Dialysis Therapy (Sixth Edition). New Delhi: Elsevier; 2023, p. 491–496.CrossRefGoogle Scholar
Lew, SQ, Wallace, EL, Srivatana, V, Warady, BA, Watnick, S, Hood, J, et al. Telehealth for home dialysis in COVID-19 and beyond: a perspective from the American society of nephrology COVID-19 home dialysis subcommittee. Am J Kid Dis 2021;77:142–148.CrossRefGoogle ScholarPubMed
Starr, MC, Altemose, K, Parsley, J, Cater, DT, Hains, DS, Soranno, DE. Safety and timeliness of telemedicine initiation of continuous kidney replacement therapy. Pediatr Nephrol 2024;39:325–329.CrossRefGoogle ScholarPubMed
End Stage Renal Disease (ESRD) Facilities: CMS Flexibilities to Fight COVID-19: Centers for Medicare & Medicaid Services; 2020 [updated March 28, 2020; cited 2024 June 13, 2024]. Available from: https://www.asn-online.org/policy/webdocs/COVID-19_ESRD_FACILITIES_508c_FINAL.pdf.Google Scholar
Interim SARS-CoV-2 Testing Guidelines for Patients in Outpatient Hemodialysis Facilities: Centers for Disease Control and Prevention; 2020 [updated December 21, 2020; cited 2024 June 25, 2024]. Available from: https://web.archive.org/web/20210101173010/https://www.cdc.gov/coronavirus/2019-ncov/hcp/dialysis/testing-patients.html.Google Scholar
Mendelssohn, DC, Mujais, SK, Soroka, SD, Brouillette, J, Takano, T, Barre, PE, et al. A prospective evaluation of renal replacement therapy modality eligibility. Nephrol Dial Transplant 2009;24:555–561.CrossRefGoogle ScholarPubMed
Bonenkamp, AA, Reijnders, TDY, van Eck van der Sluijs, A, Hagen, EC, Abrahams, AC, van Ittersum, FJ, et al. Key elements in selection of pre-dialysis patients for home dialysis. Perit Dial Int 2021;41:494–501.CrossRefGoogle ScholarPubMed
United States Renal Data System. 2023 USRDS Annual Data Report: Epidemiology of kidney disease in the United States. Bethesda, MD: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 2023.Google Scholar
Supplementary material: File

Woods et al. supplementary material

Woods et al. supplementary material
Download Woods et al. supplementary material(File)
File 149.5 KB