Excess Death Estimates in Patients with End-Stage Renal Disease - United States, February-August 2020.
Excess Death Estimates in Patients with End-Stage Renal Disease - United States, February-August 2020.
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DOI：
10.15585/mmwr.mm7022e2externalicon
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发表时间：
2021-06-04
期刊：
影响因子：
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通讯作者：
Huff, Edwin D
中科院分区：
文献类型：
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作者：
Ziemba, Robert;Campbell, Kyle N;Huff, Edwin D
终末期肾病（ESRD）是一种肾脏功能永久性衰退的疾病，需要肾脏替代治疗*来维持生命(1)。自2001年以来，美国ESRD患者的死亡率一直在下降(2)。然而，在COVID-19大流行期间，ESRD患者与COVID-19相关的发病率和死亡率的风险很高，部分原因是免疫系统减弱和存在多种合共病（3-5）。ESRD全国协调中心（ESRD NCC）通过分析数据、传播最佳实践和编写教育材料，为医疗保险和医疗补助服务中心（CMS）和ESRD网络提供支持。ESRD NCC分析了报告给Web-Enabled Network （CROWNWeb）的死亡病例，CROWNWeb是一个便于收集和维护在美国医疗保险认证的透析设施和肾移植中心治疗的慢性透析或接受肾移植的ESRD患者的信息的系统。通过比较2020年2月1日至8月31日期间每月观察到的死亡人数和预测的死亡人数，得出了超额死亡估计数；预测的死亡是根据2016年1月1日至2019年12月31日的数据建模的。该分析估计，在2020年2月1日至8月31日期间，每1000名ESRD患者中有8.7-12.9例额外死亡，或者在798,611名ESRD患者中总共有6,953-10,316例额外死亡。这些发现表明，在大流行的早期阶段，ESRD患者的死亡人数超过了根据往年数据预计的死亡人数。在规划和实施诸如COVID-19疫苗接种、感染控制指导和患者教育等干预措施时，应考虑高死亡率的地理和时间模式，包括终末期肾病患者的高死亡率。这些发现强调了数据驱动的技术援助和进一步分析ESRD患者过度死亡的原因和模式的重要性。
End-stage renal disease (ESRD) is a condition in which kidney function has permanently declined such that renal replacement therapy* is required to sustain life (1). The mortality rate for patients with ESRD in the United States has been declining since 2001 (2). However, during the COVID-19 pandemic, ESRD patients are at high risk for COVID-19-associated morbidity and mortality, which is due, in part, to weakened immune systems and presence of multiple comorbidities (3-5). The ESRD National Coordinating Center (ESRD NCC) supports the Centers for Medicare & Medicaid Services (CMS) and the ESRD Networks, through analysis of data, dissemination of best practices, and creation of educational materials. ESRD NCC analyzed deaths reported to the Consolidated Renal Operations in a Web-Enabled Network (CROWNWeb), a system that facilitates the collection of data and maintenance of information about ESRD patients on chronic dialysis or receiving a kidney transplant who are treated in Medicare-certified dialysis facilities and kidney transplant centers in the United States. Excess death estimates were obtained by comparing observed and predicted monthly numbers of deaths during February 1-August 31, 2020; predicted deaths were modeled based on data from January 1, 2016, through December 31, 2019. The analysis estimated 8.7-12.9 excess deaths per 1,000 ESRD patients, or a total of 6,953-10,316 excess deaths in a population of 798,611 ESRD patients during February 1-August 31, 2020. These findings suggest that deaths among ESRD patients during the early phase of the pandemic exceeded those that would have been expected based on previous years' data. Geographic and temporal patterns of excess mortality, including those among persons with ESRD, should be considered during planning and implementation of interventions, such as COVID-19 vaccination, infection control guidance, and patient education. These findings underscore the importance of data-driven technical assistance and further analyses of the causes and patterns of excess deaths in ESRD patients.