The COVID-19 Pandemic and access to healthcare in people with chronic kidney disease: a systematic review and meta-analysis

Deng D1, Chua J1, Liang A1, Cooper T2,3, Wong G2,3,4

1Sydney Medical School, The University of Sydney, Sydney, Australia, 2Sydney School of Public Health, The University of Sydney, Sydney, Australia, 3Centre for Kidney Research, The Children’s Hospital at Westmead, , Australia, 4Centre for Transplant and Renal Research, Westmead Hospital, , Australia

Purpose: The coronavirus disease 2019 (COVID-19) pandemic has had an unprecedented impact on healthcare systems worldwide. Patients with chronic diseases represent a vulnerable population; the effect of the pandemic on healthcare received by chronic kidney disease (CKD) patients has not yet been defined. This systematic review evaluates the effect of the COVID-19 pandemic on access to healthcare for patients with CKD.

Methods: Electronic databases (MEDLINE and EMBASE) were searched through to February 2021 for observational studies measuring healthcare access outcomes in CKD patients during COVID-19. We extracted data relevant to healthcare access before and during the pandemic, including general nephrology and telehealth consultations, kidney transplantations and dialysis services. Relative and absolute effects of the pandemic on these outcomes were pooled using a random effects model to account for between-study heterogeneity. Subgroup analysis was conducted by WHO geographical region. Certainty of the evidence was adjudicated using the GRADE approach.

Results: Twenty-two studies (at least 151,244 patients) were identified. In very low certainty evidence, a significant difference was observed in transplantation rates (RR=2.27, 95%CI=1.56-3.29, I2=91%, P<0.01; 9 studies, 130,306 patients) when comparing pre-COVID-19 and COVID-19 eras. In very low-quality evidence, six studies descriptively reported increasing utilisation of telehealth services, four studies reported reductions to general nephrology services and five studies reported interruptions to dialysis services.

Conclusions: The COVID-19 pandemic has resulted in drastic reductions in access to kidney transplantation, dialysis, and general nephrology care. Meanwhile, telehealth use has emerged as the alternate mode of healthcare delivery. Access to healthcare may represent a contributing factor to adverse outcomes for CKD patients during the pandemic and provides insight into the long-term needs of this population in the aftermath.


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