Risk and Prognosis of Omicron Infection in Patients on Home-Based Dialysis: A Retrospective Cohort Study in China

Background: Home-based renal replacement therapy (HRT), including peritoneal dialysis (PD) and home hemodialysis (HHD), has been suggested to reduce SARS-CoV-2 infection rates and improve outcomes compared to center hemodialysis (CHD), yet evidence from China remains scarce. Methods: This single-center retrospective cohort study included patients undergoing maintenance dialysis (HRT or CHD) at Ren Ji Hospital from December 1, 2022, to January 31, 2023. The primary endpoint was Omicron infection rate; secondary endpoints included infection timeline, mortality, and associated risk factors. Logistic regression was used to identify independent predictors. Results: A total of 465 patients were included: 267 in the HRT group (263 PD, 4 HHD) and 198 in the CHD group. The infection rate was significantly lower in the HRT group than in the CHD group (52.1% vs 88.4%, P<0.001). HRT was an independent protective factor against infection. No significant difference was found in mortality between HRT and CHD groups (5.3% vs 7.6%, P>0.05). Advanced age, heart failure, and low serum albumin were associated with increased risk of death following infection. Conclusion: Home-based dialysis significantly reduced the risk of Omicron infection without adversely affecting survival outcomes. Expanding HRT may have public health implications for dialysis care during future pandemics.Figure 1. Cumulative infection rate of Omicron among dialysisFigure 2. Timeline of Omicron Infection in dialysis Patients