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Kidney Week

Abstract: SA-OR26

Excess Mortality During the COVID-19 Pandemic in a Mid-Sized Dialysis Provider

Session Information

Category: Coronavirus (COVID-19)

  • 000 Coronavirus (COVID-19)

Authors

  • Weinhandl, Eric D., Satellite Healthcare, San Jose, California, United States
  • Hussein, Wael F., Satellite Healthcare, San Jose, California, United States
  • Green, Gopa B., Satellite Healthcare, San Jose, California, United States
  • Abra, Graham E., Satellite Healthcare, San Jose, California, United States
Background

Before widespread availability of vaccination, the coronavirus disease 2019 (COVID-19) pandemic incited a sharp increase in the all-cause death rate among chronic dialysis patients. Whether excess mortality has persisted during 2022 and early 2023 remains uncertain.

Methods

We analyzed the electronic health records of Satellite Healthcare, a mid-sized, not-for-profit dialysis provider. During each epidemiologic week from week 1 of 2017 to week 16 of 2023, we identified all chronic dialysis patients in centers in California, Hawaii, Tennessee, and Texas. For each patient-day, we collected age, sex, and duration of end stage kidney disease (ESKD). We fit a logistic regression of death with generalized estimation equations, adjusted for age, sex, duration of ESKD, state, and seasonality; and estimated excess mortality in 9 pandemic intervals, relative to the interval from week 1 of 2017 to week 11 of 2020, overall and by setting (in-center, home).

Results

During the pandemic era, there were 4175 deaths, or 16.5 deaths per 100 patient-years; in contrast, there were 14.5 deaths per 100 patient-years during the pre-pandemic era. As displayed, the rate of death was initially elevated between September 2020 and March 2021 (excess mortality factor, 1.34; 95% CI, 1.24-1.45), and remained elevated from July 2021 to October 2022, with excess mortality factors ranging from 1.11 to 1.18. From November 2021 to February 2023, excess mortality was more pronounced among home dialysis patients (range of excess mortality factors, 1.20-1.35 among home patients versus 1.07-1.14 among in-center patients). Since March 2023, the rate of death has been in line with the pre-pandemic norm (excess mortality factor, 0.96; 95% CI, 0.81-1.14).

Conclusion

Excess mortality during the pandemic has gradually decreased since Winter 2020-2021, although it dissipated more slowly among home dialysis patients. In Spring 2023, excess mortality is absent.