4 Renal & Urology News
MAY/JUNE 2021 www.renalandurologynews.com
FROM THE EDITORIAL ADVISORY BOARD EDITORIAL ADVISORY BOARD
Pandemic’s Effects May Provide ESKD Insights
T
he COVID-19 supplement of the 2020 US Renal Data System 2020 Annual Data Report provides important insights into dialysis and chronic kidney disease (CKD) during the COVID-19 pandemic. Key findings include 11,200 COVID-19 hospitalizations among Medicare beneficiaries during the first half of 2020, with the rate of COVID19 hospitalizations being 3-4 times higher in hemodialysis compared with peritoneal dialysis patients. All-cause mortality was 37% higher during weeks 14-17 of 2020. A particularly important finding was a 20% decline in incident end-stage kidney disease (ESKD) cases, defined as dialysis initiations and preemptive kidney transplantations, during weeks 12-19 of 2020 compared with the corresponding period during 2017-2019. What could explain a decline in new dialysis starts? Did more patients die at home without receiving dialysis, or perhaps opt for conservative therapy with the possibility of choosing dialysis at a later time point? Or did a decreased frequency of clinic visits result in delayed estimated glomerular filtration rate (eGFR) determinations and a later start of dialysis? As we attempt to explain the drop in dialysis initiation early in the pandemic, we might consider the possibility that the decline occurred in mildly symptomatic or asymptomatic patients who were not started on dialysis due to lack of eGFR determinations early in the pandemic. Examination of the age groups in which the decline occurred may help to zero in on the cause. It also is important to determine if patients started dialysis at a lower eGFR during this period and how this affected patient survival. Although early dialysis initiation was not found to be beneficial in the IDEAL study1 published in 2010, nephrologists have likely been slow to adapt these findings to clinical practice, with results from the USRDS in 2018 showing a median eGFR of 9.2 mL/min/1.73 m2 at the start of dialysis, being only marginally lower than in 2013 at 9.4 mL/ min/1.73 m2. A recent propensity score weighted analysis2 of USRDS data revealed a higher mortality risk for patients starting dialysis at higher eGFR values. These investigations suggest that some patients with late-stage CKD may be starting dialysis too soon. The COVID-19 pandemic has touched each of us in our personal and professional lives. We have sadly seen many of our patients die from this terrible illness. We have also adapted with telehealth visits, decreased office visits, and decreased laboratory determinations. The effects of these practices could affect our patients and our practices for months and years to come. Anthony J. Bleyer, MD Professor of Internal Medicine/Nephrology Wake Forest University School of Medicine Winston-Salem, North Carolina 1. Cooper BA, Branley P, Bulfone L, et al. A randomized controlled trial of early versus late initiation of dialysis. N Engl J Med. 2010; 363:609-619. 2. Bozorgmehri S, Aboud H, Chamarthi G, et al. Association of early initiation of dialysis with all-cause and cardiovascular mortality: A propensity score weighted analysis of the United States Renal Data System. Hemodial Int. 2021;25:188-197.
Medical Director, Urology
Medical Director, Nephrology
Robert G. Uzzo, MD, MBA, FACS G. Willing “Wing” Pepper Chair in Cancer Research Professor and Chairman Department of Surgery Fox Chase Cancer Center Temple University School of Medicine Philadelphia
Kamyar Kalantar-Zadeh, MD, PhD, MPH Professor & Chief, Division of Nephrology, Hypertension & Kidney Transplantation UC Irvine School of Medicine Orange, CA
Nephrologists Anthony J. Bleyer, MD, MS Professor of Internal Medicine/Nephrology Wake Forest University School of Medicine Winston-Salem, NC
Urologists Christopher S. Cooper, MD Director, Pediatric Urology Children’s Hospital of Iowa Iowa City
David S. Goldfarb, MD Professor, Department of Medicine Clinical Chief New York University Langone Medical Center Chief of Nephrology NY Harbor VA Medical Center
R. John Honey, MD Head, Division of Urology, Endourology/Kidney Stone Diseases St. Michael’s Hospital University of Toronto
Csaba P. Kovesdy, MD Chief of Nephrology Memphis VA Medical Center Fred Hatch Professor of Medicine University of Tennessee Health Science Center Memphis
Stanton Honig, MD Department of Urology Yale University School of Medicine New Haven, CT J. Stephen Jones, MD Chief Executive Officer Inova Health System Falls Church, VA Professor and Horvitz/Miller Distinguished Chair in Urologic Oncology (ret.) Cleveland Clinic Lerner College of Medicine Cleveland Jaime Landman, MD Professor of Urology and Radiology Chairman, Department of Urology UC Irvine School of Medicine Orange, CA James M. McKiernan, MD John K. Lattimer Professor of Urology Chair, Department of Urology Director, Urologic Oncology Columbia University College of Physicians and Surgeons New York Kenneth Pace, MD, MSc Assistant Professor, Division of Urology St. Michael’s Hospital University of Toronto Vancouver, Canada
Edgar V. Lerma, MD Clinical Associate Professor of Medicine Section of Nephrology Department of Medicine University of Illinois at Chicago College of Medicine Chicago Allen Nissenson, MD Emeritus Professor of Medicine The David Geffen School of Medicine at UCLA Chief Medical Officer, DaVita Inc. Denver Rulan Parekh, MD, MS Associate Professor of Pediatrics and Medicine University of Toronto Robert Provenzano, MD Associate Professor of Medicine Wayne State University School of Medicine Detroit Vice President of Medical Affairs, DaVita Healthcare Denver Robert S. Rigolosi, MD Director, Regional Hemodialysis Center Holy Name Hospital Teaneck, NJ
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Renal & Urology News (ISSN 1550-9478) Volume 20, Number 3. Published bimonthly by Haymarket Media, Inc., 275 7th Avenue, 10th Floor, New York, NY 10001. For Advertising Sales & Editorial, call (646) 638-6000 (M–F, 9am–5pm, ET). For reprint/licensing requests, contact Customer Service at custserv@haymarketmedia.com. Postmaster: Send address changes to Renal & Urology News, c/o Direct Medical Data, 10255 W. Higgins Rd., Suite 280, Rosemont, IL 60018. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means (electronic, mechanical, photocopying, recording, or otherwise) without the prior written permission of Haymarket Media, Inc. Copyright © 2021.
