COVID-19−Associated Decline in the Size of the End-Stage Kidney Disease Population in the United States

COVID-19 and kidney disease: insights from epidemiology to inform clinical practice

“… The initial weeks of the pandemic in early 2020 were associated with a decrease in the total number of individuals registered with new onset chronic kidney failure requiring KRT. In April 2020 in the USA, there was a 25% decrease in the incidence of kidney failure relative to historical projections; by 1 year after the start of the pandemic, there were about 3.5% fewer KRT patients in the USA than would have been projected 90 , 91 . Possible explanations include high mortality of patients with pre-dialysis CKD from COVID-19.…”

“…This inverse relationship may reflect mortality as a competing outcome, whereby many patients with CKD who, without COVID-19, would have progressed to chronic dialysis, instead died. There were also reduced rates of transplantation, which contributed to delayed haemodialysis initiation in some settings due to a lack of capacity 90 , 91 .…”

US Renal Data System 2021 Annual Data Report: Epidemiology of Kidney Disease in the United States

“…Together, these events brought about the first substantial shrinkage in the ESRD population. 3 Initiation of in-facility hemodialysis declined to a greater extent than initiation of peritoneal dialysis, leading to an increase in the percentage of new ESRD patients starting peritoneal dialysis that was not accompanied by an increase in new peritoneal dialysis starts. 2 …”

COVID-19 in dialysis: clinical impact, immune response, prevention, and treatment

“…Although regional disparities were observed, in the US the number of incident patients and the mean estimated glomerular filtration rate at dialysis initiation were significantly lower in 2020 than in previous years, particularly in elderly patients and non-Hispanic Blacks 27 , 28 . Overall, the size of the US dialysis population shrunk by 1,6% in 2020 29 .…”