The CDC confirm that during the 7-month period at the beginning of the COVID-19 pandemic (February-August 2020), there were 6,953-10,316 deaths in end-stage renal disease (ESRD) patients. As many as two-thirds of deaths occurred in patients undergoing hemodialysis compared to patients undergoing kidney transplantation, this was due to the fact that during the pandemic there was a unmet need for in person health services in hemodialysis centers. Studies in America state that COVID 19 accounts for 31% of deaths in ESRD patients who are hospitalized for pneumonia (approximately 6 days) with risk factors old age and elevated inflammation marker. In addition beside old age (mean age 63 years), the most comorbid comorbidities were hypertension (98%) and diabetes (69%). In the autopsy study of chronic kidney failure patients who died due to COVID-19 infection, several causes of death were found, including: septic shock and/or multi-organ failure (30.8%), suppurative pulmonary infection (19.2%, right heart failure (15.4%), respiratory failure (19.2%), and other causes are 3.8 %. This is a retrospective study by collecting data from medical records of ESRD patients as many as 103 patients undergoing routine hemodialysis at the Mardi Waluyo Hospital Lampung Indonesia during the period October 2021 to August 2021. This study was based on demographic data (age and gender), comorbid history, and body mass index of ESRD patients which infected by COVID 19 during routine hemodialysis at the hospital, both requiring inpatient and outpatient treatment. Confirmation of the diagnosis of COVID 19 using RT-PCR and the determination of moderate to severe symptoms of COVID-19 infection using clinical manifestations, measuring oxygen saturation with pulse oximetry, and radiological examination of a chest X-ray. A total of 103 patients, 38 confirmed COVID-19 patients with the number of deaths due to COVID-19 is 9 people (23.6%). Based on 38 patients infected with COVID 19, there is 17 patients (44.7%) needed hospitalization due to moderately severe COVID-19 pneumonia with total deaths during the hospitalization period being 9 patients (52.9%). A total of 9 people died, the mean age was 59 years (mean rate 44-70 years); male as many as 7 patients (77.7%) and female as many as 2 patients (22.2%); comorbid diabetes mellitus as many as 2 patients (22.2%), hypertension as many as 5 patients (55.5%), and the combination of the two comorbids was 22.2 patients (22.2%); BMI examination was found to be overweight in 5 patients (55,5%), obesity in 1 patient (11.1%), normoweight in 3 patients (33.3%). ESRD patients who were treated at the Mardi Waluyo Hospital, Lampung, Indonesia due to moderately severe COVID-19, found a mortality rate of 52.9% with an average age of 59 years (range 44-70 years);the most gender was male (77,7%);the most comorbid diseases were hypertension (55.5%); and overweight (55.5%) caused the most deaths. However, detailed information about the exact cause of death and the contribution of previous illnesses that affect the mortality rate of ESRD patients infected with COVID-19 at this hospital is still limited due to the lack of laboratory and autopsies examination facilities that should be carried out to establish the cause of death.