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

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...

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Bibliographic Details
Published in:Journal of the American Society of Nephrology 2021-11, Vol.32 (11), p.2948-2957
Main Authors: Wetmore, James B, Johansen, Kirsten L, Liu, Jiannong, Peng, Yi, Gilbertson, David T, Weinhandl, Eric D
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Catheterization, Central Venous - statistics & numerical data
Clinical Research
COVID-19 - epidemiology
Glomerular Filtration Rate
Humans
Incidence
Kidney Failure, Chronic - diagnosis
Kidney Failure, Chronic - epidemiology
Kidney Failure, Chronic - therapy
Kidney Transplantation - statistics & numerical data
Logistic Models
Middle Aged
Odds Ratio
Procedures and Techniques Utilization
Renal Dialysis - statistics & numerical data
United States
Young Adult
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Summary: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 in weeks 19-22; non-Hispanic Black patients exhibited the largest decrease, at 0.61 ml/min per 1.73 m . The odds of initiating dialysis with eGFR
ISSN:1046-6673
1533-3450
1533-3450
DOI:10.1681/ASN.2021040579