Objectives: The patients with end-stage renal disease are more vulnerable to viral epidemics showing higher mortality rate compared to general population. This is the first report demonstrating clinical outcome and associated factors among Korean maintenance hemodialysis (HD) patients who are diagnosed with coronavirus disease 2019 (COVID-19). Methods: From February 2020 and November 2021, the COVID-19 Task Force Team collected clinical data of COVID-19 confirmed HD patients using self-reported survey against nephrologists. The composite outcome included in-hospital mortality, admission to intensive care unit, and use of mechanical ventilation. Risk factors associated with clinical outcomes were analyzed among HD patients and compared with those in general population using COVID-19 database from Korean Centers for Disease Control and Prevention. Results: A total of 380 HD patients from 206 facilities were diagnosed with COVID-19. Fever (49.5%) and cough (25.7%) were the two most common initial symptoms. The overall in-hospital fatality rate was 22.4%. The non-survivors were older, more frequently developed shortness of breath and more likely to come from nursing hospital. Compared to the age- and sex-matched general population, HD patients showed higher risk of in-hospital mortality (hazard ratio 2.07, 95% confidence interval 1.56-2.75, P<0.001) and composite outcome (hazard ratio 3.5, 95% confidence interval 2.56-4.77, P<0.001). Conclusions: HD patients have higher risk of in-hospital mortality and morbidity. Attention should be paid to COVID-19 HD patients when they are older than 70, hospitalized to nursing hospital, and presented with dyspnea.