The coronavirus disease 2019 (COVID-19) pandemic has upended every aspect of life as we know it. Its effect on the health-care system has been uniquely profound, laying bare the shortcomings of our systems and processes, while at the same time creating new opportunities by rapid adaptation and utilization of available technology. Patients with end-stage kidney disease (ESKD) requiring dialysis are considered a vulnerable group with the potential for severe COVID because of their immunosuppressed status and multiple comorbidities. Patients who receive hemodialysis in the in-center setting have been significantly affected by the COVID-19 pandemic because of the specific logistics involved (need to travel to their dialysis units and receive dialysis in a communal setting, typically 3 times a week), thus increasing their risk of exposure. Although patients on home dialysis are usually able to avoid such exposure, they face their own unique challenges. In this review, we will discuss the challenges posed by the COVID-19 pandemic for patients on home dialysis, the impact of COVID-19 on various aspects of their care, and the resultant rapid adaptations in policy and health-care delivery mechanisms with significant future implications. In the context of an evolving situation and a lack of data, we have shared our personal experiences relating to these issues, where appropriate.

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