{"id":21659,"date":"2025-03-29T09:57:31","date_gmt":"2025-03-29T13:57:31","guid":{"rendered":"https:\/\/www.ices.on.ca\/?post_type=journal_article&#038;p=21659"},"modified":"2025-04-01T10:08:19","modified_gmt":"2025-04-01T14:08:19","slug":"clinical-outcomes-and-healthcare-utilization-in-patients-receiving-maintenance-dialysis-after-the-onset-of-the-covid-19-pandemic-in-ontario-canada","status":"publish","type":"journal_article","link":"https:\/\/www.ices.on.ca\/fr\/publications\/journal-articles\/clinical-outcomes-and-healthcare-utilization-in-patients-receiving-maintenance-dialysis-after-the-onset-of-the-covid-19-pandemic-in-ontario-canada\/","title":{"rendered":"Clinical outcomes and healthcare utilization in patients receiving maintenance dialysis after the onset of the COVID-19 pandemic in Ontario, Canada"},"content":{"rendered":"<p><strong>Background<\/strong> \u2014 The impact of the COVID-19 pandemic on clinical outcomes and healthcare utilization in patients receiving maintenance dialysis is unclear.<\/p>\n<p><strong>Objective<\/strong> \u2014 To compare the rates of clinical outcomes and healthcare utilization in patients receiving maintenance dialysis (in-center and home modalities) before and during the COVID-19 pandemic.<\/p>\n<p><strong>Design<\/strong> \u2014 Population-based, repeated cross-sectional study.<\/p>\n<p><strong>Setting<\/strong> \u2014 Linked administrative healthcare databases from Ontario, Canada.<\/p>\n<p><strong>Patients<\/strong> \u2014 Adults receiving maintenance dialysis from March 15, 2017, to March 14, 2020 (pre-COVID-19 pandemic period) and from March 15, 2020, to March 14, 2023 (COVID-19 pandemic period).<\/p>\n<p><strong>Measurements<\/strong> \u2014 Our primary outcome was all-cause mortality. Our secondary outcomes included non-COVID-19-related mortality, all-cause hospitalizations (excluding elective surgeries), emergency room visits, intensive care unit admissions, and hospital admissions with mechanical ventilation. We also examined cardiovascular-related hospitalizations, kidney-related outcomes, and ambulatory visits.<\/p>\n<p><strong>Methods<\/strong> \u2014 We used Poisson generalized estimating equations to model pre-COVID outcome trends and used these to predict post-COVID outcomes and to estimate the relative change (i.e., the ratio of the observed to the expected rate).<\/p>\n<p><strong>Results<\/strong> \u2014 In 31\u2009900 individuals receiving maintenance dialysis during the study period, the crude incidence rate (per 1000 person-years) of all-cause mortality was 165.0 in the pre-COVID-19 period, compared to 173.2 during the first year of the pandemic and 171.7 during the first 36 months of the pandemic. After adjustment, there was a statistically significant increase in all-cause mortality in 14 out of the 36 months of the COVID-19 period compared to the pre-COVID-19 period, with 494 recorded COVID-19-related deaths. However, when examining the overall all-cause mortality across the months, the adjusted relative rate (aRR) comparing the observed to expected all-cause mortality rate was not statistically significant in the first year of the pandemic (1.08, 95% CI: 1.00, 1.16) and the first 36 months of the pandemic (1.08, 95% CI: 0.99, 1.18) compared to the pre-pandemic period. The crude incidence rate of non-COVID-19-related mortality was 165.0 in the pre-COVID-19 period, compared to 163.3 during the first year of the pandemic and 157.7 during the first 36 months. After adjustment, there was no substantial change in the rate of non-COVID-19-related deaths in the first year of the pandemic (aRR 1.01, 95% CI: 0.94, 1.09), but there was a substantial decrease in all-cause hospitalization, with an aRR of 0.92 (95% CI: 0.88, 0.97), and a substantial decrease in emergency room visits and intensive care unit admissions; findings were consistent 36 months into the pandemic.<\/p>\n<p><strong>Limitations<\/strong> \u2014 External generalizability to other jurisdictions may be limited, with each region experiencing different COVID-19 rates and implementing different mitigation strategies.<\/p>\n<p><strong>Conclusions<\/strong> \u2014 In the maintenance dialysis population, all-cause mortality was significantly higher during several months of the pandemic; however, the overall rate of all-cause mortality was not substantially higher than expected in the first 36 months of the COVID-19 pandemic. There was no substantial increase in non-COVID-19-related mortality despite a substantial decrease in acute healthcare utilization. Ongoing monitoring of the dialysis population will offer further insights into the long-term effects of the pandemic.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Background \u2014 The impact of the COVID-19 pandemic on clinical outcomes and healthcare utilization in patients receiving maintenance dialysis is unclear. Objective \u2014 To compare the rates of clinical outcomes and healthcare utilization in patients receiving maintenance dialysis (in-center and home modalities) before and during the COVID-19 pandemic. Design \u2014 Population-based, repeated cross-sectional study. Setting [&hellip;]<\/p>\n","protected":false},"template":"","migration-helper-automated":[],"migration-manual":[],"topic":[62,49,35],"migration-helper-qa-sample-set":[],"class_list":["post-21659","journal_article","type-journal_article","status-publish","hentry","topic-health-services-research","topic-kidney-disease","topic-public-health"],"acf":{"citation":"Naylor KL, Jeyakumar N, Kang Y, Dixon SN, Garg AX, Al-Jaishi A, Blake PG, Chanchlani R, Fu L, Harel Z, Ip J, Kitchlu A, Kwong JC, Nesrallah G, Oliver MJ, Stukel TA, Wald R, Weir M, Yau K. <em>Can J Kidney Health Dis<\/em>. 2025; 12:20543581251328077.","source_url":"https:\/\/doi.org\/10.1177\/20543581251328077","ices_scientist":[1299,1208,1242,20830,1194,1256,1149,1372,1123,1127],"site":[6739],"research_program":[6743],"news_release":"","journal_article":"","atlas":"","research_report":"","infographic":"","video":"","downloads":null,"links":null,"sitecore_item_id":"","sitecore_item_name":"","sitecore_field_values":"","previous_url":""},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>ICES | Clinical outcomes and healthcare utilization in patients receiving maintenance dialysis after the onset of the COVID-19 pandemic in Ontario, Canada<\/title>\n<meta name=\"description\" content=\"Background \u2014 The impact of the COVID-19 pandemic on clinical outcomes and healthcare utilization in patients receiving maintenance dialysis is unclear.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, 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