The COVID-19 pandemic resulted in a sharp decline in kidney supply that has not yet recovered, according to a new retrospective study.
Clarissa Diamantidis, MD, MHS, of Duke University School of Medicine in Durham, North Carolina, and colleagues reported that health care utilization among Medicare beneficiaries with advanced chronic kidney disease (CKD) increased 43% year over year during the pandemic. declined.
Based on pre-pandemic health care usage – specifically, January 2019 to February 2020 – these CKD patients were expected to have had approximately 2.74 million personal health care visits during the period the pandemic occurred. However, from March to June 2020, this group only had about 1.56 million personal health visits.
“We saw a dramatic reduction in overall occupancy followed by an incomplete rebound,” said Diamantidis during a presentation of the latest findings during the National Kidney Foundation’s virtual spring meeting.
Looking at additional data, the top three procedures that saw the greatest reductions during the pandemic were orders for metabolic panels, quantitation of urine albumin, and tests for urine creatinine.
“We can all understand that these are the labs where we monitor CKD and these have been brought to the fore as the most affected procedures,” she noted.
“The pandemic has significantly reduced CKD care management, and this is broader, including use, medication coverage, and lab monitoring.”
Based on data from the United Health Group’s Medicare Advantage population, the researchers used pre-pandemic health care utilization figures to predict how high the utilization should have been in the first few months of the pandemic. This included both outpatient and inpatient health care visits, primarily for patients with stage 3 CKD, but also stage 4 CKD.
This patient population appeared to be using telemedicine rather than face-to-face visits, with telemedicine usage increasing rapidly in April and May 2020. In mid-April there were almost as many telemedicine visits as there were personal health care visits, although telehealth has never been the more popular choice. And by the end of May, fewer patients were opting for telemedicine, as personal visits increased again.
Overall, telehealth visits supplemented personal care during the pandemic months by 12.5%. However, this still resulted in a 29% health care utilization deficit for these patients compared to what was predicted if the pandemic never occurred.
Health care utilization – including in-person and telemedical visits – peaked around June 7, 2020, reaching approximately 86% of the projected number of health visits for these patients. However, this began to taper again at the end of June.
Diamantidis warned that this decrease in CRF supply will have a large downstream impact on health outcomes and could manifest itself in such a way as an increase in hospital admissions or less preparation for renal replacement therapy.
“We need to look at this ‘natural experiment’ of COVID-19 as an assessment of our models of care and really use it as an opportunity to find out which models of care are most effective for CKD populations,” she suggested. “I suspect we may find that all of the care we offer is not high quality care and we may identify key areas of inferior care, potentially shifting the CKD care model to something new and fairly innovative, but more efficient and has optimal results. “
Limitations included the lack of trend data for the later months of the pandemic as this study only looked at the first 4 months.
Diamantidis reported to be a senior clinical employee for United Health.