Maintenance dialysis patients are a vulnerable population during the COVID-19 pandemic due to their comorbid conditions and limited ability to physically distance themselves from others. This cohort study on risk factors for and outcomes from COVID-19 among patients receiving maintenance dialysis showed a 5.5% rate of infection in clinics with at least one case and that residence in a congregate setting was the strongest risk factor for disease. During this initial COVID surge period, patients receiving maintenance dialysis who contracted COVID-19 had a mortality rate approaching 25%, far higher than the general population. These data suggest that the maintenance dialysis population requires substantial support during the pandemic, whether through expanded testing, early vaccination, or coordination of complex care.