A Spatiotemporal Analysis of Hemodialysis Incidence Rate and Impact of the COVID-19 Pandemic on the End-Stage Kidney Disease Trend

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INTRODUCTION: Limited research has been conducted on the spatial trend of end-stage kidney disease (ESKD), particularly hemodialysis (HD), in developing countries. This is problematic considering the growing demand for dialysis services in these regions. To bridge this research gap, this study evaluates the spatial trend of chronic dialysis incidence rates over a significant period (2007 to early 2021) in a large population, while also investigating the influence of the COVID-19 pandemic on this trend. METHODS: We used data from the Shiraz University of Medical Sciences Specific Diseases Affairs database (2007-2021) on 8,368 dialysis patients. A Bayesian spatiotemporal model analyzed the data to estimate ESKD trends and relative risks with hemodialysis in 29 counties. RESULTS: Among the patients receiving maintenance dialysis for end-stage kidney disease (ESKD), 3,348(40%) were female and 5,020(60%) were male. The average age was 57.58 ± 17, with a median age of 56 (2-98) years. The standardized incidence rate in 2007 was 0.78, while in 2020-21, it increased to 0.86. The estimated mean relative risk was 1.20, ranging from 0.43 to 4.35. We observed a consistent fixed trend with a coefficient of 0.99. During the COVID-19 pandemic and outside of it, we noticed an increased spatiotemporal interaction in the central and northern regions of the province, despite the temporal trend remaining relatively stable. CONCLUSION: Our study reveals previously unexplored geographic disparities in ESKD incidence within Fars province from 2007 to 2021. The notable increase in dialysis cases in the central and northern regions emphasizes the urgency of addressing this public health concern.

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