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BACKGROUND AND AIMS The first documented case of SARS-CoV-2 infection was diagnosed in South Africa on the 5 March 2020 and a pandemic declared on the 25 March 2020. Patients on dialysis are at increased risk for COVID-19 infection due to their high burden of comorbidities, impaired immune response, need to attend dialysis and the higher incidence of severe disease. In this study, we evaluated the prevalence, clinical management and outcome of dialysis patients and dialysis healthcare workers who tested positive for COVID-19. Further, the study aimed to provide insight into strategies to minimize COVID-19 spread in outpatient dialysis facilities. METHOD A retrospective cohort study was conducted on 1382 chronic dialysis patients and 292 healthcare workers from 69 chronic haemodialysis centres and 17 home therapy divisions who have tested COVID-19 positive from the 5 March 2020 until the 26 July 2021. RESULTS From the 1382 chronic dialysis patients who tested positive during the study, the mean age was 57.5 ± 12.7 years of age; 61.3% of patients were male and 38.7% female. COVID-19 re-infection was prevalent in 3.5% (n = 48) of the chronic dialysis patient population within the study duration. The overall 28-day mortality rate for patients testing COVID-19 positive was 13.1% (n = 181). The mean age of patients succumbing to COVID-19 was 63.6 ± 11.1 years of age. A further, 292 healthcare workers tested positive during the study duration, 63.4% (n = 185) were frontline healthcare staff (nurses or clinical technologists) and 22.9% (n = 67) were support services and 13.7% (n = 40), were administrative staff. Only one staff member succumbed to COVID-19 (0.3%). At the end of the study duration 69% of healthcare workers and 27.6% of patients had been vaccinated. CONCLUSION The COVID-19 pandemic has had a significant impact on chronic dialysis patients. Dialysis patients are associated with more adverse clinical outcomes and increased mortality. In South Africa, better vaccination rates and more dosing and appropriate preventative strategies remain our strongest defense to mitigate excess cases and death.