University of Maryland School of Medicine, Baltimore, Maryland, USA.
Department of Medicine, Division of Nephrology, University of Maryland School of Medicine, Baltimore, Maryland, USA.
BMC Nephrol. 2024 Aug 23;25(1):269. doi: 10.1186/s12882-024-03685-w.
The Covid-19 pandemic greatly affected those with chronic diseases, impacting healthcare access and healthcare seeking behaviors. The impact of the pandemic on adults with Autosomal Dominant Polycystic Kidney Disease (ADPKD) has not been investigated.
Participants were recruited from a cohort of 239 ADPKD patients enrolled in a longitudinal study at the University of Maryland. Patients on renal replacement therapy were excluded. N = 66 patients participated in a phone questionnaire from June 2022-December 2022 about ADPKD-related complications, concern about contracting Covid-19, healthcare-seeking behaviors, and telehealth utilization before and after March 2020.
N = 34 (51.5%) of participants reported a positive Covid-19 test result. N = 29 (44%) expressed high concern of contracting Covid-19. Those who avoided medical care at least once (N = 17, 25.8%) had similar demographics and ADPKD severity to those who did not, but reported greater telehealth utilization (88.2% vs. 42.9%, p = 0.002), greater use of non-prescribed medication for Covid-19 treatment or prevention (35.3% vs. 8.2%, p = 0.01), and were more likely to contract Covid-19 (76.5% vs. 42.9%, p = 0.02). Among the N = 53 who reported very good or excellent ADPKD disease management pre-pandemic, N = 47(89%) reported no significant change during the pandemic.
In this highly educated, high-income cohort with a mean age of 46.1 years, most people reported well-managed ADPKD prior to the pandemic. This may explain why less than half of participants expressed high concern for contracting Covid-19. Overall, there was no significant pandemic-related decline in self-reported ADPKD management. This was likely due to this cohort's excellent access to, and uptake of, telehealth services. Notably, 1 in 4 participants reported healthcare avoidant behavior, the effect of which may only be seen years from now. Future studies should investigate potential impacts of avoidant behaviors, as well as expand investigation to a more diverse cohort whose care may not have been as easily transitioned to telehealth.
Covid-19 大流行极大地影响了患有慢性病的人群，影响了他们获得医疗保健的机会和寻求医疗保健的行为。大流行对常染色体显性多囊肾病（ADPKD）成人的影响尚未得到调查。
从马里兰大学一项纵向研究的 239 名 ADPKD 患者队列中招募参与者。排除正在接受肾脏替代治疗的患者。2022 年 6 月至 2022 年 12 月，共有 66 名患者通过电话问卷调查，了解 ADPKD 相关并发症、对感染 Covid-19 的担忧、医疗保健寻求行为以及 2020 年 3 月前后的远程医疗使用情况。
34 名（51.5%）参与者报告 Covid-19 检测结果呈阳性。29 名（44%）表示高度担忧感染 Covid-19。至少一次避免医疗保健的参与者（N=17，25.8%）与未避免医疗保健的参与者在人口统计学和 ADPKD 严重程度方面相似，但报告的远程医疗利用率更高（88.2%比 42.9%，p=0.002），更有可能使用非处方药物治疗或预防 Covid-19（35.3%比 8.2%，p=0.01），并且更有可能感染 Covid-19（76.5%比 42.9%，p=0.02）。在报告疫情前 ADPKD 管理非常好或极好的 53 名参与者中，47 名（89%）报告在疫情期间没有明显变化。
在这项受教育程度高、收入高的队列研究中，平均年龄为 46.1 岁，大多数人在大流行前报告 ADPKD 管理良好。这可能解释了为什么只有不到一半的参与者表示对感染 Covid-19 高度担忧。总体而言，自我报告的 ADPKD 管理并没有因大流行而显著下降。这可能是由于该队列能够极好地获得和采用远程医疗服务。值得注意的是，1/4 的参与者报告存在回避医疗保健的行为，其影响可能要在几年后才能显现。未来的研究应调查回避行为的潜在影响，并将调查范围扩大到更广泛的患者群体，这些患者的护理可能不容易过渡到远程医疗。
