tetano
Editor, Senior Moderator
J Am Soc Nephrol
. 2021 Apr 8;ASN.2021010009.
doi: 10.1681/ASN.2021010009. Online ahead of print.
Initial Effects of COVID-19 on Patients with ESKD
Eric D Weinhandl[SUP] 1 2 [/SUP], James B Wetmore[SUP] 3 4 [/SUP], Yi Peng[SUP] 3 [/SUP], Jiannong Liu[SUP] 3 [/SUP], David T Gilbertson[SUP] 3 [/SUP], Kirsten L Johansen[SUP] 3 4 [/SUP]
Affiliations
Abstract
Background: Reports from around the world have indicated a fatality rate of patients with coronavirus disease 2019 (COVID-19) in the range of 20%-30% among patients with ESKD. Population-level effects of COVID-19 on patients with ESKD in the United States are uncertain.
Methods: We identified patients with ESKD from Centers for Medicare and Medicaid Services data during epidemiologic weeks 3-27 of 2017-2020 and corresponding weeks of 2017-2019, stratifying them by kidney replacement therapy. Outcomes comprised hospitalization for COVID-19, all-cause death, and hospitalization for reasons other than COVID-19. We estimated adjusted relative rates (ARRs) of death and non-COVID-19 hospitalization during epidemiologic weeks 13-27 of 2020 (March 22 to July 4) versus corresponding weeks in 2017-2019.
Results: Among patients on dialysis, the rate of COVID-19 hospitalization peaked between March 22 and April 25 2020. Non-Hispanic Black race and Hispanic ethnicity associated with higher rates of COVID-19 hospitalization, whereas peritoneal dialysis was associated with lower rates. During weeks 13-27, ARRs of death in 2020 versus 2017-2019 were 1.17 (95% confidence interval [95% CI], 1.16 to 1.19) and 1.30 (95% CI, 1.24 to 1.36) among patients undergoing dialysis or with a functioning transplant, respectively. Excess mortality was higher among non-Hispanic Black, Hispanic, and Asian patients. Among patients on dialysis, the rate of non-COVID-19 hospitalization during weeks 13-27 in 2020 was 17% lower versus hospitalization rates for corresponding weeks in 2017-2019.
Conclusions: During the first half of 2020, the clinical outcomes of patients with ESKD were greatly affected by COVID-19, and racial and ethnic disparities were apparent. These findings should be considered in prioritizing administration of COVID-19 vaccination.
Keywords: COVID-19; dialysis; hospitalization; mortality; transplantation.
. 2021 Apr 8;ASN.2021010009.
doi: 10.1681/ASN.2021010009. Online ahead of print.
Initial Effects of COVID-19 on Patients with ESKD
Eric D Weinhandl[SUP] 1 2 [/SUP], James B Wetmore[SUP] 3 4 [/SUP], Yi Peng[SUP] 3 [/SUP], Jiannong Liu[SUP] 3 [/SUP], David T Gilbertson[SUP] 3 [/SUP], Kirsten L Johansen[SUP] 3 4 [/SUP]
Affiliations
- PMID: 33833076
- DOI: 10.1681/ASN.2021010009
Abstract
Background: Reports from around the world have indicated a fatality rate of patients with coronavirus disease 2019 (COVID-19) in the range of 20%-30% among patients with ESKD. Population-level effects of COVID-19 on patients with ESKD in the United States are uncertain.
Methods: We identified patients with ESKD from Centers for Medicare and Medicaid Services data during epidemiologic weeks 3-27 of 2017-2020 and corresponding weeks of 2017-2019, stratifying them by kidney replacement therapy. Outcomes comprised hospitalization for COVID-19, all-cause death, and hospitalization for reasons other than COVID-19. We estimated adjusted relative rates (ARRs) of death and non-COVID-19 hospitalization during epidemiologic weeks 13-27 of 2020 (March 22 to July 4) versus corresponding weeks in 2017-2019.
Results: Among patients on dialysis, the rate of COVID-19 hospitalization peaked between March 22 and April 25 2020. Non-Hispanic Black race and Hispanic ethnicity associated with higher rates of COVID-19 hospitalization, whereas peritoneal dialysis was associated with lower rates. During weeks 13-27, ARRs of death in 2020 versus 2017-2019 were 1.17 (95% confidence interval [95% CI], 1.16 to 1.19) and 1.30 (95% CI, 1.24 to 1.36) among patients undergoing dialysis or with a functioning transplant, respectively. Excess mortality was higher among non-Hispanic Black, Hispanic, and Asian patients. Among patients on dialysis, the rate of non-COVID-19 hospitalization during weeks 13-27 in 2020 was 17% lower versus hospitalization rates for corresponding weeks in 2017-2019.
Conclusions: During the first half of 2020, the clinical outcomes of patients with ESKD were greatly affected by COVID-19, and racial and ethnic disparities were apparent. These findings should be considered in prioritizing administration of COVID-19 vaccination.
Keywords: COVID-19; dialysis; hospitalization; mortality; transplantation.