COVID-19 Hospitalization and Mortality Trends Among US Dialysis Patients by Race/Ethnicity and Vaccination Status

The coronavirus disease 2019 (COVID-19) pandemic disproportionately affected vulnerable individuals, including people with kidney disease. We elucidated longitudinal trends in hospitalization and mortality among individuals receiving maintenance dialysis before and during the pandemic and explored how universal vaccine availability affected COVID-19 outcomes by race/ethnicity.

A retrospective cohort study.

Adult maintenance dialysis patients between 2018-2023 at a national not-for-profit US provider.

COVID-19 era (2020-2023), race/ethnicity.

COVID-19 vaccination status; hospitalization and death (COVID-related, all-cause).

Zero-inflated Poisson models and logistic regression models were used to calculate hospitalization and mortality rates, respectively, adjusted for age, sex, race/ethnicity, dialysis vintage, and number of comorbid conditions.

Among 41,257 patients receiving maintenance dialysis, all-cause hospitalization dropped abruptly in March/April 2020 and increased thereafter, albeit remaining below prepandemic rates. All-cause mortality exhibited typical seasonal variability during 2018-2019, subsequently increasing with onset of the COVID-19 pandemic in March 2020. Mortality peaked in January 2021 at 228 deaths per 1,000 person-years before declining to 151 deaths per 1,000 person-years in March 2021. Subsequently, mortality transiently increased during the Delta and Omicron variant periods, peaking at 188 and 189 deaths per 1,000 person-years, respectively. Thereafter, all-cause mortality remained below prepandemic levels. After widespread SARS-CoV-2 vaccine availability in 2021 with vaccine provision in dialysis facilities, the COVID-19 mortality rate among all race/ethnicity groups declined significantly (b = -5.3; P < 0.001). There were no statistically significant differences by race/ethnicity in the vaccination status at each year's end.

Potential residual confounders and underreporting of COVID-19-related outcomes.

All-cause mortality increased sharply in 2020 and early 2021, reflecting COVID-19-related deaths, whereas non-COVID-19 mortality declined during the early phase of the pandemic and subsequently remained below prepandemic levels. After introduction of SARS-CoV-2 vaccines, all-cause mortality declined to below prepandemic levels, likely reflecting the impact of widespread vaccination in the dialysis population.