#4312 CHANGES OF PATIENT CARE DURING THE COVID 19 PANDEMIC AND ITS IMPACT ON THE ADVANCED STAGE OF CKD PATIENTS
Authors: Taki Fumika , Konishi Kasumi , Kadota Nozomi , Shimoyama Kotaro , Fujimaru Takuya , Ito Yugo , Nagahama Masahiko , Nakayama Masaaki 
Published: June 2023

Abstract

Background and Aims
With the COVID-19 pandemic from the end of 2019, due to the tightening of medical care resources and intermittent lockdowns, CKD patients could not receive the full patients care or educations. However, on CKD management, patient care and education by the nephrologist and multiple professions are known to be important, especially for the late stage of CKD patients. We assessed changes of CKD patients’ management during the COVID-19 pandemic and clarify its impact on their medical conditions.

Method
Retrospective single center cohort study was conducted. From 2018 to 2021, CKD stage 4 to 5, non-dialyzed patients, who were followed in CKD out-patients clinic in St. Luke's International Hospital, Tokyo, Japan, were included. We definite the pre post pandemic periods as: pre-pandemic: Pre-C, from January 2018 to December 2019, and post-pandemic; Post-C, January 2020 to December 2021. The following data was compared between the 2 periods: Number of nephrology visits per patient; Rate of using telemedicine; Rate of receiving multidisciplinary educational support; Rate of drop-out patients; and Number of patients who initiate renal replacement therapy, newly. Clinical information and laboratory data were obtained from hospital medical record, eGFR were calculated according to MDRD formula modified for Japanese. This study was approved by research ethics committee in St. Lukes’ International hospital.

Results
Two hundreds and eighty nine individual patients were eligible for the analysis. The baseline data were as follows: mean age 67.9±14 years, 63.5% male, mean eGFR 22.2±5.9 ml/min and 40.2% comorbid DM. The number of nephrology visits and receiving multidisciplinary support was decreased in Post-C periods: Nephrology visits; Pre-C: 9.8±5.1 visits/year, Post-C 7.7±5.2 visits/year, P&lt;0.001, Multidisciplinary support; Pre-C: 78%, Post-C 32%, P&lt;0.001. Multi professional educational support was provided mainly for CKD stage 5 patients during the Post-C. More, the rate of using telemedicine and dropout increased in Post-C. Especially, the dropout rate of elderly patients over 70 years old was significant: 8% in Pre-C and 17% in Post-C, P&lt;0.001. On the other hand, clinical indicators such RRT initiation rate remained unchanged. More, there were no difference of RRT initiation rate, between on-visit and telemedicine patients.

Conclusion
Frequency of nephrology visits and multidisciplinary educational care has been decreased with COVID-19, there was no difference in the short-term prognosis of CKD patients, from our study. During the pandemic of COVID-19 infection, human conversation or contact, was restricted to prevent its spread, in all over the world. In Japan, a national survey reported that the number of outpatient hospital visits in 2020 was on average 70% of those in 2019. Our clinic also recognized the phenomenon. Some patients switched their visit to telemedicine. Telemedicine has some evidence which has equivalent value to face to face education. From our study, needs for more IT-based, contact-less device-based medical treatment and care in the future was suggested. On the other hand, the dropout rate in the elderly was increased, and these population could no easily use telemedicine. The prognosis of these patients needs to be followed up and verified.