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Abstract: TH-PO955

Variability in Excess ESKD Patient Mortality Among States During the Pandemic

Session Information

Category: Coronavirus (COVID-19)

  • 000 Coronavirus (COVID-19)

Authors

  • Weinhandl, Eric D., Chronic Disease Research Group, Minneapolis, Minnesota, United States
  • Liu, Jiannong, Chronic Disease Research Group, Minneapolis, Minnesota, United States
  • Gilbertson, David T., Chronic Disease Research Group, Minneapolis, Minnesota, United States
  • Wetmore, James B., Chronic Disease Research Group, Minneapolis, Minnesota, United States
  • Johansen, Kirsten L., Chronic Disease Research Group, Minneapolis, Minnesota, United States
Background

The incidence of death among patients with ESKD in the United States has been significantly elevated during the COVID-19 pandemic, relative to recent historical levels. In the general population, individual states have exhibited markedly variable COVID-19 death rates, possibly reflecting policy decisions concerning pandemic management. However, little is known about regional variability in the excess mortality of ESKD patients. We analyzed excess mortality among both prevalent dialysis and kidney transplant (KT) patients between March 15, 2020, and June 30, 2021.

Methods

We analyzed national data extracted from the Centers for Medicare and Medicaid Services (CMS) End Stage Quality Reporting System (EQRS). For each epidemiologic week from week 1 of 2018 to week 26 of 2021, we identified prevalent dialysis and KT patients at the beginning of each week, and the incidence of all-cause death among them during the week. For each combination of state and kidney replacement therapy, we estimated excess mortality during the pandemic (definition: week 12 of 2020 and thereafter), using a logistic regression model of death among patient-weeks, with adjustment for age, sex, race.

Results

From 732,063 dialysis patients in 50 states, there were 129,095 pandemic-era deaths; and from 238,265 KT patients in 41 states, there were 11,256 pandemic-era deaths. State-level excess mortality ratios in dialysis patients ranged from 0.96 to 1.34, with 40% of states having ratios significantly greater than 1.1. State-level excess mortality ratios in KT patients ranged from 1.02 to 2.73, with 61% of states having ratios significantly greater than 1.1.

Conclusion

States exhibited wide variability in excess ESKD patient mortality, with roughly 3-fold wider variability in prevalent KT patients than in dialysis patients.

Funding

  • NIDDK Support