{"doi":"10.1016/j.ekir.2021.07.019","title":"COVID-19−Associated Decline in the Size of the End-Stage Kidney Disease Population in the United States","abstract":"According to the United States Renal Data System (USRDS), the number of people with end-stage kidney disease (ESKD) in the United States has increased every year between 1980 and 2018.1Collins A.J. Foley R.N. Herzog C. et al.US Renal Data System 2010 annual data report.Am J Kidney Dis. 2011; 57 (A8, e1−e526)Abstract Full Text Full Text PDF Scopus (322) Google Scholar,2Johansen K.L. Chertow G.M. Foley R.N. et al.US Renal Data System 2020 annual data report: epidemiology of kidney disease in the United States.Am J Kidney Dis. 2021; 77: A7-A8Abstract Full Text Full Text PDF PubMed Scopus (335) Google Scholar Between 1980 and 2000, the increasing prevalence reflected mostly the rapidly increasing incidence of ESKD. Since 2000, the increasing prevalence has shifted toward improved survival among patients on maintenance dialysis, as well as those with a functioning kidney transplant. Recent forecasting of the size of the ESKD population had suggested continued growth during the 2020s.3McCullough K.P. Morgenstern H. Saran R. et al.Projecting ESRD incidence and prevalence in the United States through 2030.J Am Soc Nephrol. 2019; 30: 127-135Crossref PubMed Scopus (230) Google Scholar However, no forecast could have anticipated the novel coronavirus disease 2019 (COVID-19) pandemic. During the early part of the pandemic, all-cause mortality was 17% and 30% higher than expected among dialysis and transplant patients, respectively, whereas the number of patients who initiated kidney replacement therapy (KRT) declined sharply.2Johansen K.L. Chertow G.M. Foley R.N. et al.US Renal Data System 2020 annual data report: epidemiology of kidney disease in the United States.Am J Kidney Dis. 2021; 77: A7-A8Abstract Full Text Full Text PDF PubMed Scopus (335) Google Scholar,4Weinhandl E.D. Wetmore J.B. Peng Y. et al.Initial effects of COVID-19 on patients with ESKD.J Am Soc Nephrol. 2021; 32: 1444-1453Crossref PubMed Scopus (43) Google Scholar Considering that the rate of COVID-19 hospitalization was approximately 40 times higher among dialysis patients than in the general population,4Weinhandl E.D. Wetmore J.B. Peng Y. et al.Initial effects of COVID-19 on patients with ESKD.J Am Soc Nephrol. 2021; 32: 1444-1453Crossref PubMed Scopus (43) Google Scholar it is likely that substantial mortality also occurred during the past winter. In this report, we quantified the impact of COVID-19 on the size of the ESKD population at 1 year after the declaration of a national emergency. We analyzed data extracted from the End Stage Renal Disease Quality Reporting System (EQRS) in May 2021. For each epidemiologic week (Sunday to Saturday) from week 1 of 2015 to week 13 of 2021, we identified all patients with ESKD at the beginning of the week. We identified the KRT status (dialysis, transplant), age, and race/ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic, Asian, other) of each patient. We tabulated numbers of patients in subgroups defined by each of these factors. In each subgroup, we fit a linear regression of weekly counts from week 1 of 2015 to week 13 of 2021; the model included only calendar time, which was parameterized as a second-order (i.e., quadratic) polynomial. Fitted models were used to derive forecasted weekly counts through week 13 of 2021; forecasted weekly counts of ESKD patients were derived by summing forecasted counts of dialysis and transplant patients. Between week 1 of 2015 and week 13 of 2020, the numbers of dialysis and transplant patients steadily increased, with little deviation from quadratic trends (Figure 1). As of week 13 of 2020, there were 808,354 ESKD patients, comprising 572,157 patients undergoing dialysis and 236,197 patients with a transplant. As of week 13 of 2021, there were 803,661 ESKD patients, representing a year-over-year decline of 0.6% and a “deficit” of 3.5%, relative to the forecast of 833,236 ESKD patients. Among patients undergoing dialysis, the year-over-year decline in census was 1.6%, representing ","journal":"Kidney International Reports","year":2021,"id":172719,"datarank":0.4887144807032224,"base_score":3.258096538021482,"endowment":3.258096538021482,"self_citation_contribution":0.4887144807032224,"citation_network_contribution":0.0,"self_endowment_contribution":0.4887144807032224,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":25,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.8466,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2021-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":447431,"name":"David T. Gilbertson","orcid":"0000-0002-0769-7360","position":1,"is_corresponding":false},{"id":447430,"name":"James B. Wetmore","orcid":"0000-0003-1380-8597","position":2,"is_corresponding":false},{"id":265848,"name":"Kirsten L. Johansen","orcid":"0000-0001-6421-361X","position":3,"is_corresponding":false},{"id":709107,"name":"Eric D. Weinhandl","orcid":"0000-0001-8016-2015","position":0,"is_corresponding":true}],"reference_count":5,"raw_metadata":{"citation_network_status":"fetched"},"created_at":"2026-07-18T23:46:41.424716Z","pmid":"34337192","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}