Liu Richard, Abraham Rahul, Conderino Sarah E, Kanchi Rania, Blecker Saul B, Dodson John A, Thorpe Lorna E, Charytan David M, McAdams-DeMarco Mara A, Wu Wenbo
Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA.
Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA.
J Gen Intern Med. 2025 Sep 4. doi: 10.1007/s11606-025-09832-9.
The coronavirus disease 2019 (COVID-19) pandemic caused unprecedented disruptions to healthcare systems worldwide, significantly affecting patients with chronic kidney disease (CKD). In this study, we evaluated the impact of the pandemic on healthcare-seeking behavior and CKD progression among patients in New York City.
Using electronic health records from PCORnet's INSIGHT Clinical Research Network, we conducted a retrospective cohort study focused on 84,062 patients with CKD aged 50 years or older with multiple chronic conditions seen between 2017 and 2022. Patients were identified using pre-pandemic CKD diagnostic codes, and confirmed by estimated glomerular filtration rate (eGFR) measurements. Care disruption was defined as receiving fewer visits than recommended by Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. We used linear mixed-effects models to estimate annual eGFR changes and analyze trends in care visits stratified by CKD stage and care disruption.
The study cohort had a mean age of 75.8 years, 43.2% were male, and mean pre-pandemic eGFR was 51.1 mL/min/1.73 m. Care visits declined sharply in 2020 across patients at all but the end stage, with incomplete recovery by 2022. Patients with adequate pre-pandemic care maintained their visits above KDIGO levels, while those with inadequate care increased visits during the pandemic. Pronounced eGFR decline occurred in 2020 (10.6%), with slower declines observed thereafter.
The COVID-19 pandemic disrupted CKD care, potentially leading to reduced healthcare-seeking behavior and accelerated kidney function decline in 2020. Slower decline post-2020 may reflect improved healthcare utilization, better medication adherence, and new therapies, and other factors.
2019年冠状病毒病（COVID-19）大流行给全球医疗系统带来了前所未有的破坏，对慢性肾脏病（CKD）患者产生了重大影响。在本研究中，我们评估了该大流行对纽约市患者就医行为和CKD进展的影响。
利用PCORnet的INSIGHT临床研究网络中的电子健康记录，我们进行了一项回顾性队列研究，重点关注2017年至2022年间就诊的84062名年龄在50岁及以上、患有多种慢性病的CKD患者。使用大流行前的CKD诊断代码识别患者，并通过估计肾小球滤过率（eGFR）测量进行确认。护理中断定义为就诊次数少于《改善全球肾脏病预后（KDIGO）指南》推荐的次数。我们使用线性混合效应模型来估计年度eGFR变化，并分析按CKD阶段和护理中断分层的就诊趋势。
研究队列的平均年龄为75.8岁，43.2%为男性，大流行前的平均eGFR为51.1 mL/min/1.73 m²。2020年，除终末期外，所有患者的就诊次数均急剧下降，到2022年仍未完全恢复。大流行前护理充足的患者就诊次数维持在KDIGO水平以上，而护理不足的患者在大流行期间就诊次数增加。2020年出现了明显的eGFR下降（10.6%），此后下降速度较慢。
COVID-19大流行扰乱了CKD护理，可能导致2020年就医行为减少和肾功能加速下降。2020年后下降速度较慢可能反映了医疗利用率提高、更好的药物依从性、新疗法及其他因素。
