Changes in timing and preparedness for dialysis initiation in the era of COVID-19

ABSTRACT

Background: How the COVID-19 pandemic altered aspects of dialysis initiation, such as eGFR at initiation, selection of peritoneal dialysis (PD), and, in patients initiating hemodialysis (HD), use of a central venous catheter (CVC), is not fully understood. Methods: We analyzed the most recently updated quarterly USRDS data available. Using Poisson and logistic regression, we studied weekly changes in eGFR at dialysis initiation, use of PD (versus HD), and use of incident CVCs, overall and by strata of race, during the first half of 2020 compared to a forecast of 2020, had 2017-2019 historical trends continued. Results: Mean eGFR at dialysis initiation decreased by 0.33 mL/min/1.73 m2 in weeks 19-22, compared with historical trends;non-Hispanic Black patients exhibited the largest decrease, at 0.61 mL/min/1.73 m2. The odds of initiating dialysis with eGFR <10 ml/min/ 1.73m2 were highest during weeks 19-22 (May;OR 1.14, 1.05-1.17), corresponding to an absolute increase of 2.9%. Although initiation of both HD and PD fell, PD fell less, such that the odds of initiating PD (versus HD) were 24% higher (OR 1.24, 1.14-1.34) in weeks 11-14. Odds of initiating HD with a CVC increased by 30% (OR 1.30, 1.20-1.41) in weeks 15-18, representing an absolute increase of 3.3%. Conclusions: In the first half of 2020, eGFR at dialysis initiation fell, most prominently in non-Hispanic Blacks. During the initial wave of the pandemic, odds of utilizing PD, compared with HD, increased by nearly 25%, and odds of using a CVC at HD initiation increased by 30%.