Clinical Outcomes and Health Care Utilization in Patients with Advanced Chronic Kidney Disease not on Dialysis After the Onset of the COVID-19 Pandemic in Ontario, Canada
Background: The COVID-19 pandemic caused considerable disruption to health care services. Limited data exist on its impacts on clinical outcomes and health care utilization in patients with advanced chronic kidney disease (CKD). Objective: To compare the rates of all-cause mortality, cardiovascular-...
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SAGE Publishing
2025-07-01
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| Series: | Canadian Journal of Kidney Health and Disease |
| Online Access: | https://doi.org/10.1177/20543581251350030 |
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| author | Carol Wang Yuguang Kang Stephanie N. Dixon Nivethika Jeyakumar K. Scott Brimble Amit X. Garg Peter G. Blake Therese A. Stukel Matthew J. Oliver Ahmed Al-Jaishi Kristin K. Clemens Longdi Fu Jane Ip Susan McKenzie Louise Moist Amber O. Molnar Flory Muanda-Tsobo Marian Reich Pavel Roshanov Samuel A. Silver Ronald Wald Matthew A. Weir Kevin Yau Ann Young Kyla L. Naylor |
| author_facet | Carol Wang Yuguang Kang Stephanie N. Dixon Nivethika Jeyakumar K. Scott Brimble Amit X. Garg Peter G. Blake Therese A. Stukel Matthew J. Oliver Ahmed Al-Jaishi Kristin K. Clemens Longdi Fu Jane Ip Susan McKenzie Louise Moist Amber O. Molnar Flory Muanda-Tsobo Marian Reich Pavel Roshanov Samuel A. Silver Ronald Wald Matthew A. Weir Kevin Yau Ann Young Kyla L. Naylor |
| author_sort | Carol Wang |
| collection | DOAJ |
| description | Background: The COVID-19 pandemic caused considerable disruption to health care services. Limited data exist on its impacts on clinical outcomes and health care utilization in patients with advanced chronic kidney disease (CKD). Objective: To compare the rates of all-cause mortality, cardiovascular-related hospitalizations, kidney-related outcomes, and health care utilization in patients with advanced CKD before and during the first 21 months of the COVID-19 pandemic. Design: Population-based, repeated cross-sectional study from March 15, 2017 to November 15, 2021, with follow-up until December 14, 2021 (preceding the Omicron variant). Setting: Linked administrative health care databases from Ontario, Canada. Participants: Adult patients with advanced CKD, defined as an estimated glomerular filtration rate <30 mL/min/1.73 m 2 (excluding patients receiving maintenance dialysis). Measurements: The pre-COVID-19 period was from March 15, 2017 to March 14, 2020 and the COVID-19 period was from March 15, 2020 to December 14, 2021. Poisson generalized estimating equations were used to predict post-COVID-19 patient outcomes and health utilization based on pre-COVID trends, estimating relative changes between the observed and expected outcomes. The multivariable model incorporated age group-sex interaction terms, a continuous variable denoting time in months to capture general trends, and pre-COVID month indicators to adjust for seasonal changes. Methods: Our primary outcome was all-cause mortality. Secondary outcomes included all-cause hospitalizations, non–COVID-19-related deaths and hospitalizations, intensive care unit (ICU) admissions, mechanical ventilation, and emergency room visits. We also examined cardiovascular-related hospitalizations, kidney-related outcomes, and ambulatory visits. Results: We included 101 688 adults with advanced CKD. The incidence of all-cause mortality was 147.4 (95% confidence interval [CI] = 145.1, 149.7) per 1000 person-years in the pre-COVID-19 period compared to 150.8 (95% CI = 147.9, 153.7) per 1000 person-years in the COVID-19 period. After adjustment, there was an 8% higher rate of all-cause mortality during the COVID-19 (adjusted relative rate [aRR] = 1.08, 95% CI = 1.03, 1.12). Non–COVID-19-related deaths did not increase substantially (aRR = 1.02, 95% CI = 0.97, 1.07). The COVID-19 period was associated with a lower rate of all-cause hospitalizations, ICU admissions, and emergency room visits. There were declines in long-term care admissions and non-nephrology physician visits in the first 3 months of the pandemic. In contrast, nephrology visits remained stable throughout the study period, including the first 3 months of the pandemic. Similarly, the monthly rates of acute kidney injury requiring dialysis initiation showed little variation compared with pre-pandemic levels. Limitations: Due to data availability at the time of analysis, we did not examine the impact of the COVID-19 pandemic on patients with advanced CKD beyond December 2021. Conclusions: Non–COVID-19-related deaths did not increase during the first 21 months of the pandemic, despite reduced health care utilization. The study informs health service planning in future health care emergencies. |
| format | Article |
| id | doaj-art-7d44d941ba0a4ca6960f21d908dc17bc |
| institution | DOAJ |
| issn | 2054-3581 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Canadian Journal of Kidney Health and Disease |
| spelling | doaj-art-7d44d941ba0a4ca6960f21d908dc17bc2025-08-20T03:15:27ZengSAGE PublishingCanadian Journal of Kidney Health and Disease2054-35812025-07-011210.1177/20543581251350030Clinical Outcomes and Health Care Utilization in Patients with Advanced Chronic Kidney Disease not on Dialysis After the Onset of the COVID-19 Pandemic in Ontario, CanadaCarol Wang0Yuguang Kang1Stephanie N. Dixon2Nivethika Jeyakumar3K. Scott Brimble4Amit X. Garg5Peter G. Blake6Therese A. Stukel7Matthew J. Oliver8Ahmed Al-Jaishi9Kristin K. Clemens10Longdi Fu11Jane Ip12Susan McKenzie13Louise Moist14Amber O. Molnar15Flory Muanda-Tsobo16Marian Reich17Pavel Roshanov18Samuel A. Silver19Ronald Wald20Matthew A. Weir21Kevin Yau22Ann Young23Kyla L. Naylor24Divisions of Transplant Medicine and Nephrology, Cumming School of Medicine, Calgary, AB, CanadaLondon Health Sciences Centre Research Institute, ON, CanadaDepartment of Epidemiology and Biostatistics, Western University, London, ON, CanadaLondon Health Sciences Centre Research Institute, ON, CanadaDivision of Nephrology, Department of Medicine, McMaster University, Hamilton, ON, CanadaDepartment of Epidemiology and Biostatistics, Western University, London, ON, CanadaDivision of Nephrology, Western University, London, ON, CanadaInstitute of Health Policy, Management and Evaluation, University of Toronto, ON, CanadaDivision of Nephrology, Department of Medicine, University of Toronto, ON, CanadaDepartment of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, CanadaSt. Joseph’s Health Care London, ON, CanadaICES, Toronto, ON, CanadaOntario Renal Network, Ontario Health, Toronto, CanadaCanadians Seeking Solutions and Innovations to Overcome Chronic Kidney Disease, Vancouver, BC, CanadaDivision of Nephrology, Western University, London, ON, CanadaDepartment of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, CanadaICES, Toronto, ON, CanadaCanadians Seeking Solutions and Innovations to Overcome Chronic Kidney Disease, Vancouver, BC, CanadaDivision of Nephrology, Western University, London, ON, CanadaDivision of Nephrology, Kingston Health Sciences Center, Queen’s University, Kingston, ON, CanadaDepartment of Nephrology and Hypertension, Tel Aviv Medical Center, IsraelDivision of Nephrology, Western University, London, ON, CanadaDivision of Nephrology, Department of Medicine, University Health Network, Toronto, ON, CanadaDivision of Nephrology, St. Michael’s Hospital and the University of Toronto, ON, CanadaDepartment of Epidemiology and Biostatistics, Western University, London, ON, CanadaBackground: The COVID-19 pandemic caused considerable disruption to health care services. Limited data exist on its impacts on clinical outcomes and health care utilization in patients with advanced chronic kidney disease (CKD). Objective: To compare the rates of all-cause mortality, cardiovascular-related hospitalizations, kidney-related outcomes, and health care utilization in patients with advanced CKD before and during the first 21 months of the COVID-19 pandemic. Design: Population-based, repeated cross-sectional study from March 15, 2017 to November 15, 2021, with follow-up until December 14, 2021 (preceding the Omicron variant). Setting: Linked administrative health care databases from Ontario, Canada. Participants: Adult patients with advanced CKD, defined as an estimated glomerular filtration rate <30 mL/min/1.73 m 2 (excluding patients receiving maintenance dialysis). Measurements: The pre-COVID-19 period was from March 15, 2017 to March 14, 2020 and the COVID-19 period was from March 15, 2020 to December 14, 2021. Poisson generalized estimating equations were used to predict post-COVID-19 patient outcomes and health utilization based on pre-COVID trends, estimating relative changes between the observed and expected outcomes. The multivariable model incorporated age group-sex interaction terms, a continuous variable denoting time in months to capture general trends, and pre-COVID month indicators to adjust for seasonal changes. Methods: Our primary outcome was all-cause mortality. Secondary outcomes included all-cause hospitalizations, non–COVID-19-related deaths and hospitalizations, intensive care unit (ICU) admissions, mechanical ventilation, and emergency room visits. We also examined cardiovascular-related hospitalizations, kidney-related outcomes, and ambulatory visits. Results: We included 101 688 adults with advanced CKD. The incidence of all-cause mortality was 147.4 (95% confidence interval [CI] = 145.1, 149.7) per 1000 person-years in the pre-COVID-19 period compared to 150.8 (95% CI = 147.9, 153.7) per 1000 person-years in the COVID-19 period. After adjustment, there was an 8% higher rate of all-cause mortality during the COVID-19 (adjusted relative rate [aRR] = 1.08, 95% CI = 1.03, 1.12). Non–COVID-19-related deaths did not increase substantially (aRR = 1.02, 95% CI = 0.97, 1.07). The COVID-19 period was associated with a lower rate of all-cause hospitalizations, ICU admissions, and emergency room visits. There were declines in long-term care admissions and non-nephrology physician visits in the first 3 months of the pandemic. In contrast, nephrology visits remained stable throughout the study period, including the first 3 months of the pandemic. Similarly, the monthly rates of acute kidney injury requiring dialysis initiation showed little variation compared with pre-pandemic levels. Limitations: Due to data availability at the time of analysis, we did not examine the impact of the COVID-19 pandemic on patients with advanced CKD beyond December 2021. Conclusions: Non–COVID-19-related deaths did not increase during the first 21 months of the pandemic, despite reduced health care utilization. The study informs health service planning in future health care emergencies.https://doi.org/10.1177/20543581251350030 |
| spellingShingle | Carol Wang Yuguang Kang Stephanie N. Dixon Nivethika Jeyakumar K. Scott Brimble Amit X. Garg Peter G. Blake Therese A. Stukel Matthew J. Oliver Ahmed Al-Jaishi Kristin K. Clemens Longdi Fu Jane Ip Susan McKenzie Louise Moist Amber O. Molnar Flory Muanda-Tsobo Marian Reich Pavel Roshanov Samuel A. Silver Ronald Wald Matthew A. Weir Kevin Yau Ann Young Kyla L. Naylor Clinical Outcomes and Health Care Utilization in Patients with Advanced Chronic Kidney Disease not on Dialysis After the Onset of the COVID-19 Pandemic in Ontario, Canada Canadian Journal of Kidney Health and Disease |
| title | Clinical Outcomes and Health Care Utilization in Patients with Advanced Chronic Kidney Disease not on Dialysis After the Onset of the COVID-19 Pandemic in Ontario, Canada |
| title_full | Clinical Outcomes and Health Care Utilization in Patients with Advanced Chronic Kidney Disease not on Dialysis After the Onset of the COVID-19 Pandemic in Ontario, Canada |
| title_fullStr | Clinical Outcomes and Health Care Utilization in Patients with Advanced Chronic Kidney Disease not on Dialysis After the Onset of the COVID-19 Pandemic in Ontario, Canada |
| title_full_unstemmed | Clinical Outcomes and Health Care Utilization in Patients with Advanced Chronic Kidney Disease not on Dialysis After the Onset of the COVID-19 Pandemic in Ontario, Canada |
| title_short | Clinical Outcomes and Health Care Utilization in Patients with Advanced Chronic Kidney Disease not on Dialysis After the Onset of the COVID-19 Pandemic in Ontario, Canada |
| title_sort | clinical outcomes and health care utilization in patients with advanced chronic kidney disease not on dialysis after the onset of the covid 19 pandemic in ontario canada |
| url | https://doi.org/10.1177/20543581251350030 |
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