Risk and prognosis of Omicron infection in home-based dialysis patients: a retrospective cohort study in China.

BACKGROUND

Home-based dialysis, including peritoneal dialysis (PD) and home hemodialysis (HHD), has been suggested to reduce SARS-CoV-2 infection rates and improve outcomes compared to in-center dialysis, yet evidence from China remains scarce.

OBJECTIVE

To investigate the risk and prognosis of Omicron infection among patients receiving home-based dialysis versus in-center dialysis during the Omicron surge in Shanghai, China.

METHODS

This single-center retrospective cohort study included patients undergoing maintenance dialysis (home-based dialysis or in-center dialysis) at Ren Ji Hospital from December 1, 2022, to January 31, 2023. The primary endpoint was Omicron infection rate; secondary endpoints included infection timeline, all-cause mortality, and associated risk factors. Logistic regression was used to identify independent predictors.

RESULTS

A total of 465 patients were included: 267 in the home-based dialysis group (263 PD, 4 HHD) and 198 in the in-center dialysis group. The infection rate was significantly lower in the home-based dialysis group than in the in-center dialysis group (52.1% vs. 88.4%, P < .001). Home-based dialysis was an independent protective factor against infection. No significant difference was found in all-cause mortality between home-based dialysis and in-center dialysis groups (5.2% vs. 7.6%, P = .304). Advanced age, heart failure, and low serum albumin were associated with increased risk of death following infection.

CONCLUSIONS

Home-based dialysis significantly reduced the risk of Omicron infection without adversely affecting survival outcomes. Expanding home-based dialysis may have public health implications for dialysis care during future pandemics.