In-person visits among patients last known to have stage 3 to 4 chronic kidney disease (CKD) declined dramatically early in the COVID-19 pandemic compared with usual levels, and telehealth did not fully compensate for the loss in medical care, investigators revealed during the virtual National Kidney Foundation 2021 Spring Clinical Meetings.

According to data from United Health Medicare Advantage program, 2.74 million in-person visits were predicted for the early pandemic period March 1 to June 30, 2020, but only 1.56 million in-person visits occurred — a 44% loss of in-person services, Clarissa Diamantidis, MD, of Duke University in Durham, North Carolina, and colleagues reported.

Telehealth visits ramped up in April and May 2020, briefly approaching the number of in-person visits that would be expected, then declined in late May as in-person visits resumed, the investigators observed. Telehealth visits supplemented in-person care by 12.5% during the early pandemic, the investigators reported. The overall deficit in CKD care was 30%, they said. Total visits peaked in mid-June 2020 at 86% of predicted visits. Currently, CKD care appears to be at 5% below pre-pandemic utilization rates according to other sources, Dr Diamantidis told Renal & Urology News.

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In addition, the team observed a reduction in medication coverage early in the pandemic, such as the number of days patients were covered by antihypertensives and diabetes medications, and a reduction in procedures, particularly lab tests used to monitor CKD (such as metabolic panel, urinary albumin quantification, and assays of urinary creatinine).

“The downstream impact of CKD care reduction on health outcomes, such as hospitalizations or dialysis preparedness, requires further study, as does evaluation of which care delivery models are most effective for CKD populations,” Dr Diamantidis said. She said she hopes further research will distinguish areas of low value care from high value care.

Dr Diamantidis added that it is clear that nephrologists need to partner more with primary care physicians.

“The pandemic has taught us that digital care is possible and acceptable,” Dr Diamantidis said. “Prior to COVID-19, there was a great deal of hesitation about using telehealth due to reimbursement issues — which have been mitigated due to new policies — technology issues, and the desire to interact with patients. Data are showing that telehealth visits are patient-centric, cost-effective, and efficient. Telehealth does not substitute for in-person visits, but it can supplement them. Notwithstanding, the digital divide in internet access, digital readiness, and trust remain an issue.”


Diamantidis C, Cook D, Westman J, Ventura E, Redelosa C, Bartolome M, Vassalotti J. Missing care: The impact of the COVID-19 pandemic on CKD care delivery. Presented at the virtual National Kidney Foundation 2021 Spring Clinical Meetings, April 6-10, 2021. Poster 328.