1364-P: Racial and Ethnic Disparities in COVID-19 Outcomes among Dialysis Patients with Diabetes

Hemodialysis patients w/ COVID-19 have fatality rates higher than the general population. Racial minorities in the U.S. bear a disproportionate burden of diabetes and dialysis and were the hardest hit by COVID-19. Whether the impacts of COVID-19 and its outcomes on those receiving dialysis vary by race are unknown. To determine racial differences in COVID-19 infection, hospitalization, and mortality in dialysis patients w/ diabetes, we followed 114,881 in-center hemodialysis patients w/diabetes (AIAN; Asian; Black/African American: AA; Hispanic; Native Hawaiian/Other Pacific Islander: NH; Non-Hispanic White: NHW) from January 2020 to March 2022 for risk of COVID-19 infection, hospitalization, and mortality. ORs and 95% CIs were calculated, adjusting for demographic characteristics, vaccination status, vintage, and lab data. During follow-up, the cumulative incidence of COVID-19 was 26%; 34% of the population was hospitalized and 12% died. Infection rates were highest in AIAN and lowest in Asian patients: AIAN: 30%; Hispanic: 26%; NH: 22.4%; AA: 21.5; NHW: 19.8; Asian: 15.3. Risk of infection was higher in Hispanic (OR=1.36, 1.22-1.52), but lower in Asian (OR=0.69, 95% CI=0.53-0.89) patients compared to NHWs. Though Asian patients had lower infection risks, they had marginally higher hospitalization risk (OR=1.45, 95% CI=0.94-2.26; p=0.09) compared to NHW. NH were at a marginally 45% lower risk of hospitalization (OR=0.55, 95% CI =0.28-1.01; p=0.07). AA (OR=0.66, 95% CI=0.53-0.83) and Hispanic infected patients (OR=0.64, 95% CI=0.48-0.84) were at lower risk of mortality compared to NHW. Despite lower COVID-19 infection risk, US Asian dialysis patients w/ diabetes are at increased hospitalization risk when infected, whereas AIAN patients though at increased infection risk are at lower risk of hospitalization. AA and Hispanic patients are at lower risk of death. Understanding reasons for these differences may provide clues to increasing survival for dialysis patients w/ diabetes. Disclosure R.B. Conway: None. T. Quandelacy: None. M. Hu: None. Y. Wang: None. P. Kotanko: Other Relationship; Fresenius Medical Care.