Excess Deaths From End-Stage Kidney Disease Early in Pandemic | Chronic Kidney Disease | JAMA | JAMA Network
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News From the Centers for Disease Control and Prevention
July 27, 2021

Excess Deaths From End-Stage Kidney Disease Early in Pandemic

JAMA. 2021;326(4):300. doi:10.1001/jama.2021.11312

An excess of 7000 to 10 000 deaths from end-stage kidney disease (ESKD) occurred during the first several months of the COVID-19 pandemic, according to data based on ESKD mortality trends from 2016 through 2019.

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Patients with ESKD are at increased risk of death from COVID-19. Many are elderly and have multiple comorbid conditions that are associated with worse COVID-19 outcomes. Some may also have a weakened immune system. Additionally, receiving inpatient hemodialysis increases the risk of exposure to SARS-CoV-2 infection.

In the report, scientists from the Centers for Medicare & Medicaid Services analyzed data from a national registry of nearly 800 000 patients with ESKD. From February 1, 2020, through the following August, the analysis found 8.7 to 12.9 additional deaths per 1000 patients with ESKD than would have been expected based on the previous years’ data. The excess deaths peaked in the initial months of the pandemic, with a second smaller peak later in the summer of 2020.

Excess deaths among patients with ESKD were concentrated in areas that experienced high rates of COVID-19 deaths, including New York, New Jersey, Puerto Rico, the US Virgin Islands, and Texas. The excess deaths in New York were documented predominantly during the pandemic’s early months. In Texas, the increase in excess ESKD deaths occurred later in the summer, corresponding with the state’s later peak in overall COVID-19 deaths. Excess deaths among patients undergoing dialysis were 2 to 3 times higher than among patients who had undergone a kidney transplant.

“The reasons for excess deaths in the [ESKD] population might include the unmet need for in-person health services or SARS-CoV-2 transmission from other patients, staff members, or the wider community during the COVID-19 pandemic,” the authors wrote.

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