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    Fewer patients sought treatment for kidney failure in early months of COVID-19 pandemic

    Figure 1. Monthly trend in the number of patients with renal failure from January 2018 to June 2020. Credit: DOI: 10.1001 / jamanetworkopen.2021.27369

    Four months after the COVID-19 pandemic arrived in the United States, the number of patients starting treatment for renal failure decreased by 30%. JAMA network open found. In particular, black patients and patients living in counties with high COVID-19 deaths began treatment with significantly lower levels of renal function compared to the previous year.

    Unfortunately, Kevin Nguyen, a researcher at Brown University’s School of Public Health, said the results were: Chronic kidney disease There were few failures or the kidneys were healthy.Rather, the number of patients is decreasing liver Failure may reflect changes in decisions or methods of delaying treatment Health care Delivered early Pandemic.. Treatment often included regular dialysis or kidney transplantation, and two options were discontinued after the arrival of COVID-19.

    “Treatment in the form of dialysis or transplantation is essential to the survival of people with chronic kidney disease,” Nguyen said. “Missing routine care can be catastrophic. Therefore, it is very important to understand if and how the initiation of these treatments has changed with respect to a pandemic.”

    The purpose of this study was to investigate how the number and characteristics of patients who started treatment for newly diagnosed renal failure changed during the pandemic, Nguyen said. The pandemic burden has disproportionately affected members of colored races and low-income households, so researchers also wanted to specifically investigate changes within these groups.

    They used data from the medical evidence form of the renal management information system. This is a national survey of all patients with renal failure who begin long-term dialysis or undergo preemptive strikes. Kidney transplant.. They studied changes in the number of patients with renal failure starting treatment and the estimated glomerular filtration rate (eGFR), an important indicator of renal function, between March 1 and June 30, 2020. And that number is the corresponding period for 2018 and 2019. Researchers divided the analysis by race / ethnicity, county-level COVID-19 mortality, and neighborhood socio-economic characteristics.

    From March to June 2020, compared to years prior to COVID-19, kidneys that received preemptive transplantation (2.1% prior to COVID-19 vs. 1.4% of COVID-19) or started dialysis treatment The proportion of patients with failure has decreased significantly. (15.8% before COVID-19 vs. 13.4% in COVID-19). In April 2020, the number of patients who started treatment for renal failure decreased by about 30% from the previous year’s trend.

    Decreased renal function measurements were observed only among non-Hispanic black patients (8.4 mL / min / 1.73 m)2 From before COVID-19 to 8.1 in COVID-19). Patients residing in the counties with the highest number of COVID-19 deaths had a significant decrease in eGFR (9.5 vs. 9.2 during the pandemic), but patients residing in other counties did not.

    “In the early stages of the pandemic, not only did the number of people starting treatment decrease, but kidney failureBut in some groups, when treatment was started, it was when kidney function declined, “Nguyen said.

    Maximum reduction of number According to Nguyen, the number of patients seeking treatment was April 2020 compared to the previous year. Treatment initiation gradually recovered in the following months, but still did not reach pre-pandemic levels.

    The findings emphasize the importance of maintaining and improving care for people with chronic kidney disease, both throughout the pandemic and ultimately after it has subsided, Nguyen said. rice field.

    “Discontinuation of care can have serious consequences for these patients,” he said.

    The study was not designed to look at the specific mechanisms that drive these changes, but Nguyen said the plausible explanation was that patients who were afraid of getting sick and delayed treatment were limited. He said it included financial or logistical barriers to booking availability and access to care. Pandemic. He also said that in some cases the donor and patient may have decided to postpone the transplant together.

    Studies Reveal a High Burden of COVD-Related Deaths Between Kidney Transplant Recipients and Patients with Renal Failure

    For more information:
    Kevin H. Nguyen et al, Assessment of racial, ethnic, and socio-economic disparities in the initiation of renal failure treatment during the first four months of the COVID-19 pandemic, JAMA network open (2021). DOI: 10.1001 / jamanetworkopen.2021.27369

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    Brown University

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