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[The impact of the COVID-19 pandemic on renal replacement therapy]
Raúl López Blasco1,2, Jesús Ibáñez Ruiz1, Laura Puente-Santamaría1
1Unidad de Biocomputación. Instituto Aragonés de Ciencias de la Salud. Zaragoza. España.
Insights
The COVID-19 pandemic significantly increased kidney transplant waiting times and reduced transplant activity. Older men were disproportionately affected, highlighting the need for better resource management during health crises.
Area of Science:
- Nephrology
- Transplant Surgery
- Public Health
Background:
- Chronic kidney disease (CKD) requires renal replacement therapy, with kidney transplantation as the optimal solution.
- The COVID-19 pandemic disrupted healthcare, impacting organ transplantation services and patient waiting times.
- Understanding pandemic-related changes in transplant activity is crucial for healthcare planning.
Purpose of the Study:
- To compare kidney transplant activity, waiting list duration, and renal replacement therapy use before and during the COVID-19 pandemic.
- To assess the pandemic's impact on kidney transplantation at a major hospital.
- To identify demographic groups most affected by pandemic-related transplant disruptions.
Main Methods:
- Observational study of 326 kidney transplants from 2017-2022 at Miguel Servet University Hospital.
- Comparison of pre-pandemic (2017-2020) and pandemic (2020-2022) periods, excluding living or combined donor transplants.
- Statistical analysis using Kaplan-Meier curves and Cox regression models.
Main Results:
- Median kidney transplant waiting times increased from 3 to 7.5 months (p=0.0014).
- Transplant density decreased, while the use of donors in asystole significantly increased (15.1% to 34.8%).
- Older men (over 61.9 years) were the most impacted demographic.
Conclusions:
- The COVID-19 pandemic led to longer waiting times and reduced kidney transplant activity.
- Older male patients experienced a disproportionate negative impact on kidney transplantation.
- Optimizing healthcare resources is essential for managing future health crises and maintaining transplant services.
Objective:
Chronic kidney disease (CKD), characterized by progressive renal function loss, often necessitates replacement therapies to prevent mortality, with kidney transplantation being the most effective option. The COVID-19 pandemic profoundly affected healthcare systems, reducing transplant activities and lengthening waiting times. This study assesses differences in kidney transplant activity, waiting list durations, and renal replacement therapy usage during pre-pandemic and pandemic periods.
Methods:
This observational study was conducted at Miguel Servet University Hospital in Zaragoza, analyzing 326 kidney transplants performed between 2017 and 2022. Two periods were defined: pre-pandemic (2017-2020) and pandemic (2020-2022). Data were sourced from hospital records, excluding living or combined donor transplants. Statistical analyses included Kaplan-Meier survival curves and Cox regression models.
Results:
Median waiting list times increased from 3 months in the pre-pandemic period to 7.5 months during the pandemic (p=0.0014). Transplant density decreased from 5.02 to 4.21 cases per month. The proportion of donors in asystole rose significantly from 15.1% to 34.8%. Men over 61.9 years were the most impacted demographic.
Conclusions:
The pandemic significantly extends waiting times and reduces kidney transplant activities, disproportionately affecting older male patients. These findings underscore the necessity of optimizing healthcare resources in future crises.
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