Background Kidney replacement therapy (KRT) confers the highest risk of death from COVID-19. However, most data refer to the early pandemic waves. Whole year analysis in comparison with prior secular trends are scarce. Methods We present the 2020 REMER Madrid KRT registry, corresponding to the Spanish Region hardest hit by COVID-19. Results In 2020, KRT incidence decreased 12% versus 2019 while KRT prevalence decreased (−1.75%) for the first time since records began and the number of kidney transplants (KT) decreased by 16%. Mortality on KRT was 10.2% (34% higher than the mean for 2008–2019). The 2019 to 2020 increase in mortality was larger for KT (+68%) than for HD (+24%) or PD (+38%). The most common cause of death was infection (n = 419, 48% of deaths), followed by cardiovascular (200, 23%). Deaths from infection increased by 167% year over year and accounted for 95% of excess deaths in 2020 over 2019. COVID-19 was the most common cause of death (68% of infection deaths, 33% of total deaths). The bulk of COVID-19 deaths (209/285, 73%) occurred during the first COVID-19 wave, which roughly accounted for the increased mortality in 2020. Being a KT recipient was an independent risk factor for COVID-19 death. Conclusions COVID-19 negatively impacted the incidence and prevalence of KRT, but the increase in KRT deaths was localized to the first wave of the pandemic. The increased annual mortality argues against COVID-19 accelerating death of patients with short life expectancy and the temporal pattern of COVID-19 mortality suggests that appropriate healthcare may improve outcomes.

Background The COVID pandemic has resulted in a major disruption in healthcare that has affected several medical and surgical specialties. European and American Vascular Societies has proposed deferring the creation of an elective vascular access (VA) (autologous or prosthetic arteriovenous fistula (AVF or AVG) in incident patients on hemodialysis (HD) in the era of a COVID pandemic. The aim of this study is to examine the impact of COVID pandemic on VA creation and the CVC-related hospitalizations and complications in HD patients dialyzed in 16 Spanish HD units of 3 different regions. Methods We compared retrospectively two periods of time: the pre-COVID (January 1th 2019-March 11th 2020) and the COVID era (March 12th 2020-June 30th 2021) in all HD patients (prevalent and incident) dialyzed in our 16 HD centers. The variables analyzed were: type of VA (central venous catheter-CVC, AVF and AVG) created, percentage of CVC in incident and prevalent HD, CVC-related hospitalizations and complications (infection, extrusion, disfunction, catheter removal) and percentage of CVC-HD sessions that did not reach the goal of KT(KT> 45) as marker of HD adequacy. Results 1791 VA for HD were created and 905 patients started HD during the study period. Patients who underwent vascular access surgery during COVID period compared to those who did not were significantly younger and a significant decrease of surgical activity to create AVFs and AVGs in older HD patients (> 75 and > 85 years) was observed in COVID period compared to Pre-COVID period. There was a significant increase in CVC placement (from 59.7% to 69.5%) (p<0.001) from the pre-COVID to the COVID time-period. During COVID pandemic a significantly higher number of patients started HD through a CVC (80.3% vs. 69.1%, p<0.001) The percentage of CVC in prevalent HD patients has not decreased 19 months after the start of the pandemic (414 CVC/1058 prevalent patients (39.4%). No significant changes were detected in CVC-related hospitalizations between the pre-COVID and COVID periods. In COVID period a significant increase in catheter replacement and in the percentage of HD session that not reach the HD dose objective (KT> 45) was observed. Conclusions COVID has presented a public health system crisis that has influenced VA for HD with an increase of CVC relative to AVF. A decrease in HD session that not reach the HD dose objective was observed in COVID period compared to preCOVID period.

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