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From the Editorial Advisory Board

Pandemic’s Effects May Provide ESKD Insights

The COVID-19 supplement of the 2020 US Renal Data System 2020 Annual Data Report provides important insights into dialysis and chronic kidney disease (CKD) during the COVID-19 pandemic. Key findings include 11,200 COVID-19 hospitalizations among Medicare beneficiaries during the first half of 2020, with the rate of COVID19 hospitalizations being 3-4 times higher in hemodialysis compared with peritoneal dialysis patients. All-cause mortality was 37% higher during weeks 14-17 of 2020. A particularly important finding was a 20% decline in incident end-stage kidney disease (ESKD) cases, defined as dialysis initiations and preemptive kidney transplantations, during weeks 12-19 of 2020 compared with the corresponding period during 2017-2019.

What could explain a decline in new dialysis starts? Did more patients die at home without receiving dialysis, or perhaps opt for conservative therapy with the possibility of choosing dialysis at a later time point? Or did a decreased frequency of clinic visits result in delayed estimated glomerular filtration rate (eGFR) determinations and a later start of dialysis?

As we attempt to explain the drop in dialysis initiation early in the pandemic, we might consider the possibility that the decline occurred in mildly symptomatic or asymptomatic patients who were not started on dialysis due to lack of eGFR determinations early in the pandemic. Examination of the age groups in which the decline occurred may help to zero in on the cause. It also is important to determine if patients started dialysis at a lower eGFR during this period and how this affected patient survival.

Although early dialysis initiation was not found to be beneficial in the IDEAL study1 published in 2010, nephrologists have likely been slow to adapt these findings to clinical practice, with results from the USRDS in 2018 showing a median eGFR of 9.2 mL/min/1.73 m2 at the start of dialysis, being only marginally lower than in 2013 at 9.4 mL/ min/1.73 m2. A recent propensity score weighted analysis2 of USRDS data revealed a higher mortality risk for patients starting dialysis at higher eGFR values. These investigations suggest that some patients with late-stage CKD may be starting dialysis too soon.

The COVID-19 pandemic has touched each of us in our personal and professional lives. We have sadly seen many of our patients die from this terrible illness. We have also adapted with telehealth visits, decreased office visits, and decreased laboratory determinations. The effects of these practices could affect our patients and our practices for months and years to come.

Anthony J. Bleyer, MD

Professor of Internal Medicine/Nephrology Wake Forest University School of Medicine Winston-Salem, North Carolina

1. Cooper BA, Branley P, Bulfone L, et al. A randomized controlled trial of early versus late initiation of dialysis. N Engl J Med. 2010; 363:609-619. 2. Bozorgmehri S, Aboud H, Chamarthi G, et al. Association of early initiation of dialysis with all-cause and cardiovascular mortality: A propensity score weighted analysis of the United States Renal Data System. Hemodial Int. 2021;25:188-197.


Medical Director, Urology

Robert G. Uzzo, MD, MBA, FACS

G. Willing “Wing” Pepper Chair in Cancer Research Professor and Chairman Department of Surgery Fox Chase Cancer Center Temple University School of Medicine Philadelphia Urologists

Christopher S. Cooper, MD

Director, Pediatric Urology Children’s Hospital of Iowa Iowa City

R. John Honey, MD

Head, Division of Urology, Endourology/Kidney Stone Diseases St. Michael’s Hospital University of Toronto

Stanton Honig, MD

Department of Urology Yale University School of Medicine New Haven, CT

J. Stephen Jones, MD

Chief Executive Officer Inova Health System Falls Church, VA Professor and Horvitz/Miller Distinguished Chair in Urologic Oncology (ret.) Cleveland Clinic Lerner College of Medicine Cleveland

Jaime Landman, MD

Professor of Urology and Radiology Chairman, Department of Urology UC Irvine School of Medicine Orange, CA

James M. McKiernan, MD

John K. Lattimer Professor of Urology Chair, Department of Urology Director, Urologic Oncology Columbia University College of Physicians and Surgeons New York

Kenneth Pace, MD, MSc

Assistant Professor, Division of Urology St. Michael’s Hospital University of Toronto Vancouver, Canada Medical Director, Nephrology

Kamyar Kalantar-Zadeh, MD, PhD, MPH

Professor & Chief, Division of Nephrology, Hypertension & Kidney Transplantation UC Irvine School of Medicine Orange, CA


Anthony J. Bleyer, MD, MS

Professor of Internal Medicine/Nephrology Wake Forest University School of Medicine Winston-Salem, NC

David S. Goldfarb, MD

Professor, Department of Medicine Clinical Chief New York University Langone Medical Center Chief of Nephrology NY Harbor VA Medical Center

Csaba P. Kovesdy, MD

Chief of Nephrology Memphis VA Medical Center Fred Hatch Professor of Medicine University of Tennessee Health Science Center Memphis

Edgar V. Lerma, MD

Clinical Associate Professor of Medicine Section of Nephrology Department of Medicine University of Illinois at Chicago College of Medicine Chicago

Allen Nissenson, MD

Emeritus Professor of Medicine The David Geffen School of Medicine at UCLA Chief Medical Officer, DaVita Inc. Denver

Rulan Parekh, MD, MS

Associate Professor of Pediatrics and Medicine University of Toronto

Robert Provenzano, MD

Associate Professor of Medicine Wayne State University School of Medicine Detroit Vice President of Medical Affairs, DaVita Healthcare Denver

Robert S. Rigolosi, MD

Director, Regional Hemodialysis Center Holy Name Hospital Teaneck, NJ

Renal & Urology News Staff

Editor Jody A. Charnow Web editor Natasha Persaud Production editor Kim Daigneau Group creative director Jennifer Dvoretz Production manager Brian Wask Vice president, sales operations and production Louise Morrin Boyle National accounts manager William Canning Editorial director, Haymarket Oncology Lauren Burke Vice president, content, medical communications Kathleen Walsh Tulley Chief commercial officer James Burke, RPh President, medical communications Michael Graziani Chairman & CEO, Haymarket Media Inc. Lee Maniscalco




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8 Urologists Are Performing More Renal Access Procedures for PCNL The proportion of urologists obtaining renal access for percutaneous nephrolithotomy rose from 12.8% in 2007 to 32.3% in 2017.

10 Prostate RT May Up Survival in mHSPC Investigators demonstrated a bene t from radiation therapy directed at the primary prostate tumor.

12 ADT, Dementia Linked in Younger Men Androgen deprivation therapy in men aged 40 to 64 years with nonmetastatic prostate cancer ups the risk for new-onset dementia and depression.

13 Inducing Hypothermia During PN Not Bene cial The strategy does not preserve remaining kidney function, according to researchers.


11 NSAIDs Linked to Reduced Kidney Function Any exposure to nonsteroidal anti-in ammatory drugs was associated with a 71% increased risk of incident eGFR less than 60 mL/min/1.73 m2 , a study found.

11 Lupus Nephritis in SLE Increases Risk for Preeclampsia, Study Shows In a study of pregnant women with systemic lupus erythematosus, 25.7% of those with LN had preeclampsia versus 2.9% of those without renal involvement.

18 SMI Predicts KT Outcomes in Older Men A low skeletal muscle index in male kidney transplant recipients aged 60 years or older increases the risks for a combined endpoint of graft failure and death.

19 Psoriasis Therapy Bene cial in ESKD The condition increases risk for certain infections, but treating it decreases risk for some of these infections and improves survival, investigators reported.

Structural inequities in our society leave a number of ethnic and minority groups at a distinct disadvantage when it comes to things like the ability to donate a kidney.


Editor’s note: Given the pandemic-related uncertainty whether live in-person medical conferences will take place, Renal & Urology News has omitted the cities in which they had been scheduled.

Canadian Urological Association

Annual Meeting June 26–29

European Association of Urology

Annual Congress July 9–13

American Urological Association

Annual Meeting September 10–13

International Continence Society

Annual Meeting October 12–15

American Society of Nephrology

Kidney Week November 2-7

Society of Urologic Oncology

Annual Meeting December 1-3



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27 Ethical Issues in Medicine Managing uncertainty in patient care