Impact of SARS-CoV-2 on Hemodialysis Among Medicare Beneficiaries in Five Northeastern States, January 2019-December 2020

Abstract Background: The COVID-19 pandemic in the United States is on-going and has impacted healthcare practices substantially. Consistent access to healthcare and, particularly, dialysis services are essential to the management of end stage renal disease (ESRD). The objective of this analysis was to examine patterns of outpatient hemodialysis utilization and outcomes of ESRD and COVID-19 in the 5 states with highest incidence of COVID-19 during the early stages of the pandemic. Methods: We used data from the Centers for Medicare and Medicaid Services (CMS) to examine trends in receipt of outpatient hemodialysis in 2019 and 2020 among Medicare beneficiaries with fee-for-service (FFS) coverage. Results: We found that average monthly hemodialysis rates for beneficiaries with ESRD without COVID-19 were stable over time at average monthly rates of between 2.5 and 2.8 sessions per person per week in both 2019 and 2020. Beneficiaries with COVID-19, both with and without pre-existing ESRD, had hemodialysis rates that varied monthly with an average of 2.5 sessions per week per person. Adjusted death rates were highest among beneficiaries with COVID-19 and pre-existing ESRD, followed by beneficiaries with COVID-19 and no pre-existing ESRD. There was little within-group variation in hemodialysis utilization by race/ethnicity but age- and sex- adjusted death rates varied considerably by racial and ethnic group. Conclusions: Dialysis facilities were able to provide hemodialysis sessions at typical rates despite challenges during the COVID-19 pandemic. However, patients with ESRD who contracted COVID-19 had remarkably high death rates, highlighting the need for ongoing efforts to protect at-risk populations from COVID-19.