Kidney Failure-related Excess Mortality During the First Three Years of the COVID-19 Pandemic in the United States: a Nation-wide, Population-based Analysis

Overview

Journal BMC Public Health

Publisher Biomed Central

Date 2025 Jan 20

PMID 39833787

Authors

Zhenhu Chen

Pingping Jia

Di Xie

Jingyu Xie

Juan Liu

Wangnan Cao

Lefei Han

Jinjun Ran

Shengzhi Sun

Shi Zhao

Yang Ge

Leonardo Martinez

Xin Chen

Peihua Cao

Affiliations

Soon will be listed here.

Abstract

Background: The onset of the COVID-19 pandemic has had a detrimental impact on the healthcare system. Patients with kidney failure and related kidney disease are notably vulnerable to the COVID-19 pandemic. However, it remains unclear how mortality trends associated with kidney failure have evolved over the past three years. In this study, we investigated temporal trends in excess kidney failure-related mortality during the first three years of the pandemic in the United States.

Methods: We aim to estimate time-varying excess kidney failure-related mortality, which is defined as the difference between observed mortality and expected mortality predicted by a Poisson log-linear regression model, in the United States (March 2020-March 2023).

Results: Our findings revealed two distinct peaks in excess kidney failure-related mortality during the first year (March 2020-February 2021) and the second year (February 2021-March 2022), whereas a notable decline in excess mortality was observed in the third year (March 2022-March 2023). Additionally, disparities in mortality were evident among various demographic groups, including age, sex, racial/ethnic subgroups, and geographic regions. Across all age subgroups, an increase in kidney failure-related mortalities was observed, with individuals aged 85 years and above experiencing the most substantial relative increase, reaching 9595.8 per million persons (95% CI: 9438.8, 9752.9). Moreover, excess kidney failure-related mortalities were recorded at 510.3 per million persons (95% CI: 502.6, 517.9) and 721.8 per million persons (95% CI: 713.4, 730.1) for women and men, respectively. Notably, non-Hispanic Blacks exhibited the highest excess mortality within the racial/ethnic group, registering at 772.6 per million persons (95% CI: 756.3, 788.9).

Conclusions: Our study observed high levels of excess kidney failure-related mortality during the first two years of the pandemic, followed by a notable decline in the third year. This highlights the effectiveness of current policies and prevention measures implemented to mitigate the impact of the pandemic.

References

Stumpf J, Siepmann T, Lindner T, Karger C, Schwobel J, Anders L . Humoral and cellular immunity to SARS-CoV-2 vaccination in renal transplant versus dialysis patients: A prospective, multicenter observational study using mRNA-1273 or BNT162b2 mRNA vaccine. Lancet Reg Health Eur. 2021; 9:100178. PMC: 8299287. DOI: 10.1016/j.lanepe.2021.100178. View

Eriksson K, Campoccia-Jalde F, Rysz S, Rimes-Stigare C . Continuous renal replacement therapy in intensive care patients with COVID-19; survival and renal recovery. J Crit Care. 2021; 64:125-130. PMC: 8052481. DOI: 10.1016/j.jcrc.2021.04.002. View

Hiremath S, McGuinty M, Argyropoulos C, Brimble K, Brown P, Chagla Z . Prescribing Nirmatrelvir/Ritonavir for COVID-19 in Advanced CKD. Clin J Am Soc Nephrol. 2022; 17(8):1247-1250. PMC: 9435977. DOI: 10.2215/CJN.05270522. View

Yao X, Han L, Sun Y, He D, Zhao S, Ran J . Temporal variation of excess deaths from diabetes during the COVID-19 pandemic in the United States. J Infect Public Health. 2023; 16(4):483-489. PMC: 9873362. DOI: 10.1016/j.jiph.2023.01.018. View

Han L, Zhao S, Cao W, Javanbakht M, Ran J, Sun S . Changes in renal failure mortality during the COVID-19 pandemic in the United States. J Nephrol. 2021; 34(6):2167-2170. PMC: 8379559. DOI: 10.1007/s40620-021-01145-4. View

Seet C, Lindsey B, Sivaprakasam R, McCafferty K, Forbes S, Akhtar M . The management of dialysis access thrombosis during the COVID-19 pandemic. J Vasc Access. 2021; 24(4):660-665. DOI: 10.1177/11297298211045578. View

Pan X, Xu D, Zhang H, Zhou W, Wang L, Cui X . Identification of a potential mechanism of acute kidney injury during the COVID-19 outbreak: a study based on single-cell transcriptome analysis. Intensive Care Med. 2020; 46(6):1114-1116. PMC: 7106051. DOI: 10.1007/s00134-020-06026-1. View

Truong T, Dittmar M, Ghaffari A, Lin E . Policy and Pandemic: The Changing Practice of Nephrology During the Coronavirus Disease-2019 Outbreak. Adv Chronic Kidney Dis. 2020; 27(5):390-396. PMC: 7311906. DOI: 10.1053/j.ackd.2020.06.003. View

Brogan M, Ross M . The Impact of Chronic Kidney Disease on Outcomes of Patients with COVID-19 Admitted to the Intensive Care Unit. Nephron. 2021; 146(1):67-71. PMC: 8678261. DOI: 10.1159/000519530. View

10.

Han L, Zhao S, Li S, Gu S, Deng X, Yang L . Excess cardiovascular mortality across multiple COVID-19 waves in the United States from March 2020 to March 2022. Nat Cardiovasc Res. 2024; 2(3):322-333. DOI: 10.1038/s44161-023-00220-2. View

11.

Williams A, Clayton H, Singleton J . Racial and Ethnic Disparities in COVID-19 Vaccination Coverage: The Contribution of Socioeconomic and Demographic Factors. Am J Prev Med. 2021; 62(4):473-482. PMC: 8598940. DOI: 10.1016/j.amepre.2021.10.008. View

12.

Hakroush S, Tampe D, Korsten P, Tampe B . Impact of the COVID-19 Pandemic on Kidney Diseases Requiring Renal Biopsy: A Single Center Observational Study. Front Physiol. 2021; 12:649336. PMC: 8297651. DOI: 10.3389/fphys.2021.649336. View

13.

Mallah S, Ghorab O, Al-Salmi S, Abdellatif O, Tharmaratnam T, Iskandar M . COVID-19: breaking down a global health crisis. Ann Clin Microbiol Antimicrob. 2021; 20(1):35. PMC: 8129964. DOI: 10.1186/s12941-021-00438-7. View

14.

Silver S, Beaubien-Souligny W, Shah P, Harel S, Blum D, Kishibe T . The Prevalence of Acute Kidney Injury in Patients Hospitalized With COVID-19 Infection: A Systematic Review and Meta-analysis. Kidney Med. 2020; 3(1):83-98.e1. PMC: 7723763. DOI: 10.1016/j.xkme.2020.11.008. View

15.

Acosta R, Irizarry R . A Flexible Statistical Framework for Estimating Excess Mortality. Epidemiology. 2022; 33(3):346-353. PMC: 10200579. DOI: 10.1097/EDE.0000000000001445. View

16.

Hooper M, Napoles A, Perez-Stable E . COVID-19 and Racial/Ethnic Disparities. JAMA. 2020; 323(24):2466-2467. PMC: 9310097. DOI: 10.1001/jama.2020.8598. View

17.

Boyarsky B, Werbel W, Avery R, Tobian A, Massie A, Segev D . Antibody Response to 2-Dose SARS-CoV-2 mRNA Vaccine Series in Solid Organ Transplant Recipients. JAMA. 2021; 325(21):2204-2206. PMC: 8100911. DOI: 10.1001/jama.2021.7489. View

18.

Tummalapalli S, Warnock N, Mendu M . The COVID-19 Pandemic Converges With Kidney Policy Transformation: Implications for CKD Population Health. Am J Kidney Dis. 2020; 77(2):268-271. PMC: 7648180. DOI: 10.1053/j.ajkd.2020.10.004. View

19.

Li S, Han L, Shi H, Chong M, Zhao S, Ran J . Excess deaths from Alzheimer's disease and Parkinson's disease during the COVID-19 pandemic in the USA. Age Ageing. 2022; 51(12). DOI: 10.1093/ageing/afac277. View

20.

Rincon-Arevalo H, Choi M, Stefanski A, Halleck F, Weber U, Szelinski F . Impaired humoral immunity to SARS-CoV-2 BNT162b2 vaccine in kidney transplant recipients and dialysis patients. Sci Immunol. 2021; 6(60). DOI: 10.1126/sciimmunol.abj1031. View