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In the new @USRDS Annual Data Report is a chapter about the impact of #COVID19 on the ESKD patient population. A thread follows... https://adr.usrds.org/2020/covid-19-supplement/1-covid-19-supplement
We present data through epidemiologic week 27, which ended on July 4. There are lags in data, and as one moves through the third quarter, data become increasingly incomplete. With that disclaimer aside...
Among dialysis patients, the #COVID19 hospitalization rate rapidly increased between mid-March and mid-April, declined through May, and then began to increase again during June.
Interestingly, the association of age with #COVID19 hospitalization risk is complex than perhaps anticipated. Older age was a risk factor initially, but in June, the pattern had, to a limited extent, actually reversed.
Blacks experienced a higher hospitalization rate initially, but by June, Whites and Blacks had similar rates.
Meanwhile, a large disparity between Hispanic and non-Hispanic patients emerged during the late spring.
And there is this: a large difference in hospitalization rates between patients on HD and patients on PD.
An important issue is excess mortality. Here, we see large substantial excess mortality among dialysis patients in 2020 vs. 2017-2019. During the first wave, excess mortality was approximately 37%.
In patients with functioning transplants, the story was similar. Rates of death were lower, of course, than in patients on dialysis, but excess mortality was actually higher, at 61% during the first wave.
Likely to nobody's surprise, hospitalization rates for non-COVID-related reasons cratered among dialysis patients with Medicare coverage during the second quarter.
To pick one example, here are heart failure hospitalization rates among hemodialysis patients in 2020 vs. 2017-2019.
Last, but not least: ESKD incidence declined by roughly 20% during the spring. Displayed here are weekly counts of incident ESKD patients in 2020 vs. 2017-2019.
(Note that these data do not adjust for the gradual aging of the US population.)
(Note that these data do not adjust for the gradual aging of the US population.)
It's quite clear that #COVID19 has struck the ESKD population in the US to a degree that is, from a quantitative perspective alone, unprecedented.
