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The COVID-19 pandemic led to a stark decline in kidney care that has yet to rebound, a new retrospective study suggested.

Overall healthcare utilization dropped by 43% during the pandemic among Medicare beneficiaries with advanced chronic kidney disease (CKD) compared with the year prior, reported Clarissa Diamantidis, MD, MHS, of Duke University School of Medicine in Durham, North Carolina, and colleagues.

Based on healthcare utilization prior to the pandemic -- specifically January 2019 through February 2020 -- these CKD patients were expected to have roughly 2.74 million in-person healthcare visits during the period in which the pandemic hit. But from March through June 2020, this group only actually had about 1.56 million in-person healthcare visits.

"We found a dramatic reduction in overall utilization followed by a rebound that was incomplete," Diamantidis said during a presentation of the late-breaking findings during the virtual National Kidney Foundation Spring Clinical Meeting.

Looking at additional data, the top three procedures that saw the greatest reductions during the pandemic were orders for metabolic panels, urine albumin quantification, and assays of urine creatinine.

"All of us can appreciate these are the labs we use to monitor CKD and those came to the forefront as the most impacted procedures," she noted.

"The pandemic has significantly reduced CKD care management, and this is across the board, including utilization, medication coverage, and lab monitoring."

Drawing on data from the United Health Group Medicare Advantage population, the researchers used pre-pandemic healthcare utilization numbers to predict what utilization should have been throughout the early pandemic months. This included both outpatient and inpatient healthcare visits predominantly for patients with stage 3 CKD, but also included stage 4 CKD.

This patient population did seem to take to telehealth in place of in-person visits, with a rapid increase in telehealth utilization seen in April and May 2020. During mid-April, there were almost as many telehealth visits as face-to-face healthcare visits, although telehealth was never the more popular choice. And by the end of May, fewer patients were opting for telehealth, as in-person visits were picking back up.

Overall, telehealth visits supplemented face-to-face care by 12.5% throughout the pandemic months. However, this still left a healthcare utilization deficit of 29% for these patients compared with what was predicted if the pandemic never happened.

Healthcare utilization -- including face-to-face and telehealth visits -- peaked around June 7, 2020, reaching about 86% of what was the predicted amount of healthcare visits for these patients. However, this already began tapering back down by late June.

Diamantidis warned that this reduction in CKD care will lead to a large downstream impact on health outcomes, and could manifest in ways such as an uptick in hospitalizations or less renal replacement therapy preparedness.

"We need to take this 'natural experiment' of COVID-19 and look at it as an evaluation of our care delivery models and really use it as an opportunity to identify which care delivery models are most effective for CKD populations," she suggested. "I suspect we may find that all the care we are providing is not high-value care, and in fact may identify significant areas of low-value care, which may flip the model of CKD care to something that is new and rather innovative, but more efficient and has optimal outcomes."

Limitations included a lack of trend data on the later months of the pandemic, since this study only looked at the initial 4 months.

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