*Purpose: To assess the unique needs of at-risk kidney and transplant patients and their caregivers during COVID-19, we established a telephone Listening Center enabling them to share about challenges seeking care, common stressors, and opportunities for healthcare delivery improvement.

*Methods: We conducted a mixed methods study where participants answered open and closed-ended questions about their health, financial, and emotional challenges during COVID-19. Data from open-ended questions were analyzed using thematic analysis. Descriptive statistics were run for quantitative items to explore frequencies of COVID-related stressors.

*Results: The 111 participants varied by race/ethnicity [Hispanic (29%), White (24%), Asian (23%), Black (23%), Other (1%)], with most being English-speakers (85%). Many participants experienced health, financial, or emotional COVID-19 related stressors (Table). Patients reported severe limitations due to need for social distancing, inability to go to overcrowded medical settings and public spaces, and difficulty receiving assistance replacing in-home dialysis supplies, childcare support, or help with home repairs. Using the Patient Health Questionnaire (PHQ4), 30% of participants reported feeling depressed and 35% reported feeling anxious on several to most days. Participants sought emotional support from family, friends, and communities of faith using facetime and zoom. Patients wanted a centralized place to receive COVID-19 updates, recommendations for safe activities, flexibility to choose online or in person medical visits, and regular follow up from their kidney/transplant specialists related to COVID-19.

*Conclusions: Over 40% of patients reported fear, frustration, loneliness, and postponed medical visits due to COVID-19. Needs-based interventions include mental health resources, education, and support for care transitions may be helpful, particularly as the pandemic continues.

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