During the COVID-19 surge in the United States in early 2020, patients with end-stage kidney disease (ESKD) suffered greatly.

According to the US Renal Data System 2020 annual data report, during the first half of 2020, there were 11,200 COVID-19 hospitalizations among Medicare beneficiaries undergoing dialysis. Compared with the same periods in 2017-2019, all-cause mortality among all patients receiving dialysis in 2020 was 37% higher from March 29 to April 25 and 16% higher from April 26 to July 4. Among patients with a functioning kidney transplant, excess mortality was 61% and 25%, respectively. Kirsten L. Johansen, MD, and her peers published the new data in the American Journal of Kidney Diseases.

New study findings published in the Journal of the American Society of Nephrology corroborate these trends. Based on data from the Centers for Medicare & Medicaid Services Renal Management Information System, COVID-19 hospitalizations peaked between March 22 and April 25, 2020 among patients on dialysis receiving Medicare, and the rate was approximately 40-fold higher than that in the general population, Eric D. Weinhandl, PhD, MS, of the Chronic Disease Research Group in Minneapolis, Minnesota, and colleagues reported. During weeks 13-27 of 2020 (March 22-July 4), patients undergoing dialysis or who had a functioning kidney transplant also had higher than expected death risk.

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The investigators broke down COVID-19 hospitalization rates into 3 periods: epidemiologic weeks 13-17, 18-22, and 23-27 of 2020. During these periods, Black patients had an approximately 1.6-, 1.8- and 2.2-fold increased adjusted relative rates of COVID-19 hospitalization, respectively, compared with White patients; Hispanic patients had approximately 1.6-, 1.6- and 3.2-fold higher rates, respectively. Asian patients had a 46% increased rate during the weeks 13 to 17, but the rates did not differ significantly during the other weeks.

Peritoneal dialysis was associated with a 67% lower risk for COVID-19 hospitalization compared with hemodialysis.

In addition, during March 22 to July 4, the risk for all-cause mortality was 17% and 30% higher among patients on dialysis and with a functioning transplant, respectively, compared with the same weeks in 2017-2019. Death risk from any cause was higher among Black, Hispanic, and Asian patients than White patients, the investigators reported. During weeks 13-27 of 2020, White patients on dialysis or with a functioning transplant had a 7% and 20% higher adjusted relative rate of death, respectively, compared with 2017-2019.  Black patients on dialysis or with a functioning transplant had a 35% and 84% increased rate, respectively. Hispanic patients had a 27% and 90% increased rate, and Asian patients had a 28% and 38% increased rate.

Notably, during the same early pandemic period in 2020, the rate of hospitalization for causes other than COVID-19 among dialysis patients was 17% lower compared with 2017-2019.

“Patients with ESKD were severely affected by COVID-19 during the first half of 2020, to the extent that excess mortality in patients on dialysis and with a transplant led to contraction of the ESKD census,” Dr Weinhandl’s team stated. “Racial and ethnic disparities in COVID-19 hospitalization and excess mortality further demonstrated the health inequities that have been widely discussed during 2020.”

Vaccination may be the only intervention that can significantly stem morbidity and mortality in the ESKD population, and these patients should be prioritized for COVID-19 vaccines, according to the study authors.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Johansen KL, GM Chertow, Foley RN, et al. US Renal Data System 2020 annual data report: Epidemiology of kidney disease in the United States. Am J Kidney Dis. 77(4): A7-A8.doi:10.1053/j.ajkd.2021.01.002

Weinhandl E, Wetmore J, Peng Y, Liu J, Gilbertson D, Johansen K. Initial effects of COVID-19 on patients with ESKD. Published online April 8, 2021. J Am Soc Nephrol. doi:10.1681/ASN.2021010009