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Changes in Treatment of Patients with Incident ESKD during the Novel Coronavirus Disease 2019 Pandemic.
Wetmore, James B; Johansen, Kirsten L; Liu, Jiannong; Peng, Yi; Gilbertson, David T; Weinhandl, Eric D.
  • Wetmore JB; Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota james.wetmore@hcmed.org.
  • Johansen KL; Division of Nephrology, Hennepin Healthcare, Minneapolis, Minnesota.
  • Liu J; Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota.
  • Peng Y; Division of Nephrology, Hennepin Healthcare, Minneapolis, Minnesota.
  • Gilbertson DT; Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota.
  • Weinhandl ED; Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota.
J Am Soc Nephrol ; 32(11): 2948-2957, 2021 11.
Article in English | MEDLINE | ID: covidwho-1496700
ABSTRACT

BACKGROUND:

The COVID-19 pandemic caused major disruptions to care for patients with advanced CKD.

METHODS:

We investigated the incidence of documented ESKD, ESKD treatment modalities, changes in eGFR at dialysis initiation, and use of incident central venous catheters (CVCs) by epidemiologic week during the first half of 2020 compared with 2017-2019 historical trends, using Centers for Medicare and Medicaid Services data. We used Poisson and logistic regression for analyses of incidence and binary outcomes, respectively.

RESULTS:

Incidence of documented ESKD dropped dramatically in 2020 compared with the expected incidence, particularly during epidemiologic weeks 15-18 (April, incidence rate ratio [IRR], 0.75; 95% CI, 0.73 to 0.78). The decrease was most pronounced for individuals aged ≥75 years (IRR, 0.69; 95% CI, 0.66 to 0.73). Pre-emptive kidney transplantation decreased markedly during weeks 15-18 (IRR, 0.56; 95% CI, 0.46 to 0.67). Mean eGFR at dialysis initiation decreased by 0.33 ml/min per 1.73 m2 in weeks 19-22; non-Hispanic Black patients exhibited the largest decrease, at 0.61 ml/min per 1.73 m2. The odds of initiating dialysis with eGFR <10 ml/min per 1.73 m2 were highest during weeks 19-22 (May, OR, 1.14; 95% CI, 1.05 to 1.17), corresponding to an absolute increase of 2.9%. The odds of initiating peritoneal dialysis (versus hemodialysis) were 24% higher (OR, 1.24; 95% CI, 1.14 to 1.34) in weeks 11-14, an absolute increase of 2.3%. Initiation with a CVC increased by 3.3% (OR, 1.30; 95% CI, 1.20 to 1.41).

CONCLUSIONS:

During the first wave of the COVID-19 pandemic, the number of patients starting treatment for ESKD fell to a level not observed since 2011. Changes in documented ESKD incidence and other aspects of ESKD-related care may reflect differential access to care early in the pandemic.
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Full text: Available Collection: International databases Database: MEDLINE Document Type: Article Main subject: COVID-19 / Kidney Failure, Chronic Subject: COVID-19 / Kidney Failure, Chronic Type of study: Diagnostic study / Etiology study / Incidence study / Prognostic study / Risk factors Language: English Journal: J Am Soc Nephrol Clinical aspect: Etiology / Prognosis Year: 2021

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Full text: Available Collection: International databases Database: MEDLINE Document Type: Article Main subject: COVID-19 / Kidney Failure, Chronic Subject: COVID-19 / Kidney Failure, Chronic Type of study: Diagnostic study / Etiology study / Incidence study / Prognostic study / Risk factors Language: English Journal: J Am Soc Nephrol Clinical aspect: Etiology / Prognosis Year: 2021
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