Excess Death Due to COVID-19 in Dialysis: Results from the Taiwan Renal Data System, 2021-2022

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Background: From 2019 to 2022, Taiwan faced unprecedented challenges to population health due to the COVID-19 pandemic. It is unclear how the impacts of the COVID-19 pandemic affect the center's dialysis death. This study aims to quantify the impacts of COVID-19 on additional deaths in patients with end-stage kidney disease who underwent dialysis at centers. Methods: This study utilized the Taiwan Renal Data System database from 2017 to 2022 to detect deaths per week within each observed year in patients with long-term (≧3 months) prevalent dialysis. The deaths in 2017–2020 were considered non-COVID-19-related to detect excessive deaths due to the 2021–2022 COVID-19 endemic in Taiwan. Additionally, we quantified the impacts of different patient characteristics such as age (0–64, 65–74, 75–84, and ≥85 years), sex (male and female), diabetes mellitus (with and without), and modality (hemodialysis and peritoneal dialysis) to identify the vulnerable population in dialysis. Results: The average annual mortality rate for the period 2017–2020 was 11.8% ± 0.16%. In contrast, the rates were 12.3% and 14.6% in 2021 and 2022, respectively. It displays a higher death number in each week during the 2021–2022 COVID-19 endemic than the control periods (Figure 1). After developing a model using 2017–2020 data to predict the number of deaths per week, the average excess number of deaths in 2021 and 2022 was 40 patients per week, with a 95% confidence interval of 31–49. The excess number accounts for 9.6% of the 2021 mortality rate and 23.8% of the 2022 mortality rate. Older age, male, comorbidity with DM, and hemodialysis have a higher average excess number of deaths compared to their counterparts. Conclusion: The study demonstrates that the COVID-19 endemic has a substantial impact on the survival of patients undergoing center dialysis after universal vaccination. The evidence highlights the need for a novel care delivery system to help establish a resilient, equitable, and sustainable care system.

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