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. 2021 Nov;32(11):2948-2957.
doi: 10.1681/ASN.2021040579. Epub 2021 Sep 17.

Changes in Treatment of Patients with Incident ESKD during the Novel Coronavirus Disease 2019 Pandemic

James B Wetmore  1   2 , Kirsten L Johansen  1   2 , Jiannong Liu  1 , Yi Peng  1 , David T Gilbertson  1 , Eric D Weinhandl  1   3
Affiliations

Changes in Treatment of Patients with Incident ESKD during the Novel Coronavirus Disease 2019 Pandemic

James B Wetmore et al. J Am Soc Nephrol. 2021 Nov.

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.

Keywords: COVID-19; ESKD; USRDS; dialysis; transplantation.

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Figures

Figure 1.
Figure 1.
Weekly counts of documented ESKD incidence during weeks 3–26 of 2017–2020.
Figure 2.
Figure 2.
Adjusted, interval-specific IRRs of documented ESKD during 2020 versus the forecast of 2020, had the secular trend of 2017–2019 continued.
Figure 3.
Figure 3.
Adjusted, interval-specific IRRs of documented ESKD during 2020 versus the forecast of 2020, had the secular trend of 2017–2019 continued, in subgroups defined by age (left panel) and race/ethnicity (right panel).
Figure 4.
Figure 4.
Adjusted, interval specific IRRs of HD, PD, and preemptive KT during 2020 versus the forecast of 2020, had the secular trend of 2017–2019 continued.
Figure 5.
Figure 5.
Adjusted, interval-specific differences in mean eGFR during 2020 versus the forecast of 2020, had the secular trend of 2017–2019 continued.
Figure 6.
Figure 6.
Adjusted, interval-specific differences in mean eGFR during 2020 versus the forecast of 2020, had the secular trend of 2017–2019 continued, in subgroups defined by age (left panel) and race/ethnicity (right panel).
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References

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