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

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.