Initial Effects of COVID-19 on Patients with ESKD

Abstract

BackgroundReports 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.MethodsWe 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.ResultsAmong 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.ConclusionsDuring 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.