Changes in Treatment of Patients with Incident ESKD during the Novel Coronavirus Disease 2019 Pandemic.
Adolescent
Adult
Aged
COVID-19
/ epidemiology
Catheterization, Central Venous
/ statistics & numerical data
Glomerular Filtration Rate
Humans
Incidence
Kidney Failure, Chronic
/ diagnosis
Kidney Transplantation
/ statistics & numerical data
Logistic Models
Middle Aged
Odds Ratio
Procedures and Techniques Utilization
Renal Dialysis
/ statistics & numerical data
United States
Young Adult
COVID-19
ESKD
USRDS
dialysis
transplantation
Journal
Journal of the American Society of Nephrology : JASN
ISSN: 1533-3450
Titre abrégé: J Am Soc Nephrol
Pays: United States
ID NLM: 9013836
Informations de publication
Date de publication:
11 2021
11 2021
Historique:
received:
29
04
2021
accepted:
11
08
2021
pubmed:
19
9
2021
medline:
11
11
2021
entrez:
18
9
2021
Statut:
ppublish
Résumé
The COVID-19 pandemic caused major disruptions to care for patients with advanced CKD. 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. 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 m 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.
Sections du résumé
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 m
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.
Identifiants
pubmed: 34535558
pii: 00001751-202111000-00027
doi: 10.1681/ASN.2021040579
pmc: PMC8806095
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
2948-2957Commentaires et corrections
Type : CommentIn
Type : CommentIn
Informations de copyright
Copyright © 2021 by the American Society of Nephrology.
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