The COVID-19 pandemic caused major disruptions to care for patients with advanced CKD.

We investigated the incidence of documented ESKD, ESKD treatment modalities, changes in eGFR at dialysis initiation, and use of incident central venous catheters (CVCs) by epidemiologic week during the first half of 2020 compared with 2017–2019 historical trends, using Centers for Medicare and Medicaid Services data. We used Poisson and logistic regression for analyses of incidence and binary outcomes, respectively.

Incidence of documented ESKD dropped dramatically in 2020 compared with the expected incidence, particularly during epidemiologic weeks 15–18 (April, incidence rate ratio [IRR], 0.75; 95% CI, 0.73 to 0.78). The decrease was most pronounced for individuals aged ≥75 years (IRR, 0.69; 95% CI, 0.66 to 0.73). Pre-emptive kidney transplantation decreased markedly during weeks 15–18 (IRR, 0.56; 95% CI, 0.46 to 0.67). Mean eGFR at dialysis initiation decreased by 0.33 ml/min per 1.73 m² in weeks 19–22; non-Hispanic Black patients exhibited the largest decrease, at 0.61 ml/min per 1.73 m². The odds of initiating dialysis with eGFR <10 ml/min per 1.73 m² were highest during weeks 19–22 (May, OR, 1.14; 95% CI, 1.05 to 1.17), corresponding to an absolute increase of 2.9%. The odds of initiating peritoneal dialysis (versus hemodialysis) were 24% higher (OR, 1.24; 95% CI, 1.14 to 1.34) in weeks 11–14, an absolute increase of 2.3%. Initiation with a CVC increased by 3.3% (OR, 1.30; 95% CI, 1.20 to 1.41).

During the first wave of the COVID-19 pandemic, the number of patients starting treatment for ESKD fell to a level not observed since 2011. Changes in documented ESKD incidence and other aspects of ESKD-related care may reflect differential access to care early in the pandemic.

COVID-19 大流行对晚期 CKD 患者的护理造成了重大干扰。

我们利用医疗保险中心，根据流行病学周，研究了 2020 年上半年记录的 ESKD 的发生率、ESKD 治疗方式、透析开始时 eGFR 的变化以及事件中心静脉导管 (CVC) 的使用情况，与 2017-2019 年的历史趋势相比。和医疗补助服务数据。我们分别使用泊松和逻辑回归来分析发生率和二元结果。

与预期发病率相比，2020 年记录的 ESKD 发病率大幅下降，特别是在流行病学第 15 至 18 周期间（4 月，发病率比 [IRR]，0.75；95% CI，0.73 至 0.78）。对于年龄≥75 岁的个体，下降最为明显（IRR，0.69；95% CI，0.66 至 0.73）。第 15-18 周期间，先发制人的肾移植显着下降（IRR，0.56；95% CI，0.46 至 0.67）。第 19-22 周，透析开始时的平均 eGFR 每 1.73 m ²降低 0.33 ml/min；非西班牙裔黑人患者的下降幅度最大，为每 1.73 m ² 0.61 ml/min。在 eGFR <10 ml/min/1.73 m ²时开始透析的几率在第 19-22 周期间最高（5 月，OR，1.14；95% CI，1.05 至 1.17），绝对增加了 2.9%。第 11-14 周开始腹膜透析（与血液透析相比）的几率高出 24%（OR，1.24；95% CI，1.14 至 1.34），绝对增加 2.3%。初始 CVC 增加了 3.3%（OR，1.30；95% CI，1.20 至 1.41）。

在第一波 COVID-19 大流行期间，开始治疗 ESKD 的患者数量降至 2011 年以来未观察到的水平。记录的 ESKD 发病率和 ESKD 相关护理其他方面的变化可能反映了早期获得护理的差异大流行。