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.