Abstract: PUB005
Dialysis Initiation Practices during the COVID-19 Pandemic among US Veterans in Veterans Affairs (VA) and Non-VA Settings
Session Information
Category: Coronavirus (COVID-19)
- 000 Coronavirus (COVID-19)
Authors
- Wang, Virginia, Durham VA Health Care System, Durham, North Carolina, United States
- Coffman, Cynthia, Durham VA Health Care System, Durham, North Carolina, United States
- Meyer, Cassie Lee, Durham VA Health Care System, Durham, North Carolina, United States
- Jiang, Lan, Providence VA Medical Center, Providence, Rhode Island, United States
- Goodwin, Kaitlyn B., Durham VA Health Care System, Durham, North Carolina, United States
- Diamantidis, Clarissa Jonas, Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States
- O'Hare, Ann M., VA Puget Sound Health Care System Seattle Division, Seattle, Washington, United States
- Mor, Vincent, Providence VA Medical Center, Providence, Rhode Island, United States
- Maciejewski, Matthew L., Durham VA Health Care System, Durham, North Carolina, United States
- Trivedi, Amal, Providence VA Medical Center, Providence, Rhode Island, United States
Background
Veterans undergoing dialysis are susceptible to fragmented care in both VA and non-VA settings and their initiation of dialysis may be particularly affected by disruptions in care during the COVID-19 pandemic.
Methods
In this retrospective cohort study, we compared dialysis initiation practices among Veterans initiating dialysis through the Veterans Affairs (VA) in VA or VA community care (VACC) (i.e., non-VA) settings in 2018-2022. Changes in dialysis initiation were assessed across COVID eras (January 2018-February 2020 [pre], March 2020-December 2020 [acute], January 2021-January 2022 [recovery]) and dialysis settings (VA and non-VA). Dialysis initiation outcomes included nephrology visit ≤12 months prior to dialysis onset, estimated glomerular filtration rate (eGFR) ≤90 days of dialysis onset, and receipt of arterio-ventricular (AV) access placement. Linear and logistic models were fit with inverse probability of treatment weights that adjusted for Veterans’ demographic, clinical, and healthcare utilization characteristics, and area-level COVID infection and vaccination rates.
Results
In adjusted analyses, the 17,780 Veterans in the cohort initiated VA dialysis during the study period (58% pre, 19% acute, and 24% recovery COVID eras) and most (77%) received dialysis in VA community care settings. Overall, there was a diminishing mean rate of pre-dialysis nephrology visits across COVID eras (67% pre, 66% acute, 60% recovery; p-value <0.0001) that was present in both VA and non-VA settings. Across all COVID eras, mean eGFR was higher in VA (14.3 vs. 13.4 in VACC; p<0.01), indicating lower kidney function at dialysis initiation, and mean rate of AV placement was also slightly higher in VA (13% vs. 10% in VACC; p<0.01).
Conclusion
Among US Veterans, COVID-19 was associated with overall decrease in nephrology consultation prior to dialysis initiation. There were no observed changes in kidney function or AV placement at dialysis onset over time. However, differences in conditions of dialysis initiation among Veterans in VA and non-VA settings persisted throughout the pandemic. Future analysis should further examine pandemic-related outcomes in this vulnerable population.
Funding
- Veterans Affairs Support