Patients receiving maintenance hemodialysis were highly vulnerable during the coronavirus disease 2019 pandemic because treatment continuity required repeated exposure to healthcare settings, while multiple comorbidities increased severe infection risk. Although many studies reported clinical outcomes in dialysis populations, fewer assessed hospitalization costs, particularly in Eastern Europe. This study evaluated hospitalization costs among maintenance hemodialysis patients admitted with COVID-19 during pandemic waves in Romania: Wave 1 (March–May 2020), Wave 2 (October 2020–February 2021), and Wave 3 (July–November 2021). We conducted a retrospective cohort study using linked administrative and clinical databases from a Romanian tertiary nephrology center. The source database included 126 entries. After exclusion of records lacking complete reimbursement or admission/discharge data, 84 hospitalization episodes were eligible for analysis. The dataset included the first two waves: 23 admissions in Wave 1 and 61 in Wave 2. Mean hospitalization cost increased from 6,216.51 RON in Wave 1 to 8,478.76 RON in Wave 2, while median cost increased from 3,094.44 RON to 5,281.90 RON. Mean length of stay decreased significantly from 18.39 to 11.61 days (P = 0.0047). Mean cost per hospitalization day increased significantly from 426.30 RON/day to 767.47 RON/day (P = 0.0013). Total hospitalization cost correlated positively with length of stay (Spearman’s ρ = 0.50, P < 0.001). Data from Wave 3 were limited and interpreted descriptively. The second pandemic wave was associated with shorter admissions and higher daily hospitalization costs, suggesting more intensive inpatient management. These findings support prioritization of dialysis patients in future preparedness and healthcare resource planning.
