The number of patients starting treatment for end-stage kidney disease (ESKD) in the US dropped sharply during the first wave of the COVID-19 pandemic, with the most pronounced decline occurring among individuals aged 75 years or older, according to a new study.

“The abrupt decline in documented ESKD incidence is unprecedented: the approximately 2200 persons per week known to reach ESKD during the initial height of the pandemic has not been observed since 2011,” James B. Wetmore, MD, MS, of the Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, and colleagues reported in the Journal of the American Society of Nephrology.

During the initial height of the pandemic (epidemiologic weeks 15-18; April 2020), the documented incidence of ESKD decreased by 25% overall and 31% among those aged 75 years or older compared with corresponding periods in 2017-2019.

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Using data from the US Renal Data System, Dr Wetmore’s team assessed the incidence of documented ESKD during epidemiologic weeks 3 to 26 of 2020 (January 12 to June 27) and compared it with the corresponding weeks of 2017-2019.

An epidemiologic week begins on a Sunday and ends on the next Saturday. For each week, the investigators identified all patients aged 18 years or older with newly diagnosed ESKD (defined as initiation of maintenance dialysis or receipt of a preemptive kidney transplant).

In 2017-2019, the mean weekly number of patients with newly diagnosed ESKD was 2676 during weeks 3-10 and 2542 during weeks 11-26. In 2020, the mean weekly number of patients newly diagnosed with ESKD was comparable during weeks 3-10 (2694), but was sharply lower during weeks 11-26 (2203), Dr Wetmore and colleagues reported.

“Nephrologists may have deliberately chosen to delay dialysis initiation as the pandemic unfolded,” the investigators stated. “Whether this benefitted or harmed patients is uncertain.”

Although initiation of both hemodialysis (HD) and peritoneal dialysis (PD) declined in the first half of 2020, initiation of PD declined less, Dr Wetmore’s team noted.

“Because patients who plan to initiate PD are generally healthier than those who start HD and have higher health literacy, it is possible patients who initiated PD navigated the transition to dialysis better during the pandemic,” the authors explained. “In contrast, the emphasis on physical distancing may have cast PD as a therapy preferable to in-center HD among nephrologists and/or a subset of patients undecided between modalities.”


Wetmore J, Johansen K, Liu J et al. Changes in treatment of patients with incidence end-stage kidney disease during the novel Coronavirus Disease 2019 pandemic. J Am Soc Nephrol. Published online September 17, 2021. doi:10.1681/ASN.2021040579