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USRDS Releases 2022 Interactive Annual Data Report

The Chronic Disease Research Group (CDRG), in partnership with the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), announces the release of the 2022 United States Renal Data System (USRDS) Annual Data Report (ADR).

The 2022 USRDS ADR contains data from medical claims through 2020 and from some ESRD-related metrics through the first half of 2021. As such, this is the first year in which the wide-ranging effects of the coronavirus disease 2019 (COVID-19) pandemic on the CKD and ESRD populations can be placed into the full context of the years that preceded its onset. Another important aspect of this year’s ADR is a continued focus on racial, ethnic, and socioeconomic disparities in access to healthcare and outcomes. For the full ADR executive summary, click here.

The devastating effects of the COVID-19 pandemic on the CKD and ESRD populations permeate the 2022 ADR:

  • Over 10% of patients with CKD, 13% of patients with a kidney transplant, and 20% of patients on dialysis in January of 2020 were diagnosed with COVID-19 by the end of June 2021, rates that were approximately 50%, 100%, and 200% higher than that of Medicare beneficiaries without CKD, respectively.
  • The incidence of hospitalization after COVID-19 diagnosis among patients with CKD was more than double that of patients without CKD in 2020; patients receiving dialysis consistently had hospitalization rates higher still than those with CKD.
  • Mortality at 14, 30, and 90 days after diagnosis of COVID-19 was more than twice as high among beneficiaries with CKD as among those without. Nearly one-quarter of patients with CKD who were diagnosed with COVID-19 died within 90 days. Mortality after COVID-19 diagnosis was even higher for patients with ESRD, reaching 40.5% for patients on dialysis and 44.1% among kidney transplant recipients 90 days after diagnosis.
  • The ultimate result of the higher incidence of COVID-19 and higher mortality after diagnosis of COVID-19 among patients with CKD and ESRD was the unprecedented shrinking of the prevalence of diagnosed CKD and ESRD in 2020. As a result of fewer patients reaching diagnosed ESRD and the increase in mortality rate among patients with ESRD attributable to the pandemic and its effects, the rate of prevalent ESRD decreased by almost 2% in 2020.
  • As a direct result of this higher COVID-19-related mortality and, possibly, more limited access to non-COVID-19-related medical care, mortality increased more among Black than among White beneficiaries with stage 4 and 5 CKD in 2020. This resulted in a reversal of the longstanding observation of lower mortality among Black patients. In other words, whereas Black beneficiaries had lower mortality than White ones in 2019 and prior years, they had higher mortality than their White counterparts in 2020. A similar reversal of the Black-White mortality difference occurred in transplant recipients. The mortality difference did not reverse among patients treated with dialysis, but it did narrow from 43% higher mortality among White patients in 2019 to only 30% higher mortality in 2020.

Other direct and indirect effects of COVID-19 and the changes in availability and delivery of healthcare that occurred in 2020 can be seen throughout the ADR and in many metrics typically tracked in the CKD and ESRD populations. Examples include:

  • There was a particularly steep reduction in the rate of all-cause hospitalization in 2020 (14.9%) among patients with CKD; this single-year decrease was larger than the cumulative change over the previous 6-year period from 2013 to 2019.
  • Although the overall rate of hospitalization with acute kidney injury (AKI) decreased in 2020 (likely related to the overall reduction in hospitalization rate), AKI events worsened, as indicated by a 16% increase in the need for dialysis among those with AKI.
  • Outcomes after AKI requiring dialysis (AKI-D) during a COVID-19 hospitalization in 2020-2021 were substantially worse than outcomes after AKI-D without COVID-19: almost three-quarters (74.1%) of those with COVID-19 and AKI-D died during hospitalization or were discharged to hospice care compared with 35.2% of those without COVID-19 (Figure 4.4c).
  • Inflation-adjusted overall Medicare fee-for-service (FFS) spending for older (≥66 years) beneficiaries with nondialysis-dependent CKD decreased by almost 3% in 2020, or by ~$2.2B. Inpatient spending decreased by 4%, which was a combination of a ~$2.4B decrease in spending on non-COVID-19 hospitalization plus approximately $1.4B in spending for COVID-19 hospitalization.
  • The percentage of patients initiating HD with a catheter increased in 2020 to 71.2%, and the corresponding percentage initiating with an AVF decreased to 25% overall (including AVFs that were maturing or were in use, or 14.1% for AVFs used at dialysis initiation.
  • The number of patients with ESRD newly added to the kidney transplant waitlist in 2020 decreased by 12%. The percentage of dialysis patients on the kidney transplant waitlist also declined in 2020.
  • The rate of receipt of living donor kidney transplants among patients on dialysis decreased by 27.3% in 2020.
  • The number of children with incident ESRD decreased in 2020, driven primarily by a reduction in the number who received a preemptive kidney transplant. The rates of kidney transplantation among children receiving dialysis decreased by 6% in 2020.
  • Total Medicare spending for beneficiaries with ESRD decreased by $2.2B in 2020. Medicare FFS spending for ESRD beneficiaries as a percentage of total FFS spending decreased to 6.1% in 2020 after 10 years at 7.1-7.2%.

Other, non-COVID-19 related highlights

  • Among recipients of both deceased and living donor transplants, one-year survival and five-year graft survival improved. This contrasts with the frequently repeated assertion that long term outcomes after transplant have not accompanied improvements in short term outcomes.
  • Medical records documented pain in almost three-quarters of patients in the 6 months before and after starting dialysis.

Racial, Ethnic, and Socioeconomic Disparities

In this year’s ADR, we examined disparities in prevalence and treatment of CKD among Black and Hispanic individuals among younger Medicaid beneficiaries aged 18 to 64 in this year’s ADR. We found little disparity by race/ethnicity or by neighborhood deprivation in receipt of medications or nephrology encounters. However, younger Medicare beneficiaries saw nephrologists less than half as often as older Medicare beneficiaries. Thus, the younger, more heavily Black, Hispanic, and lower socioeconomic status (SES) Medicaid population appeared to have considerably less access to nephrology care.  In addition, there was substantial disparity in receipt of a living donor kidney transplant and treatment with home dialysis.

Review the ADR executive summary for a more in-depth look at the effects of COVID-19 as well as racial, ethnic, and socioeconomic disparities affecting the CKD and ESRD populations. The USRDS serves the kidney community through research, analysis, and investigator-initiated research. If you have any questions about the 2022 ADR, please contact USRDS.

About the USRDS

The core purpose of the USRDS ADR is to characterize the impact of chronic kidney disease on the US population and to support research and policy initiatives designed to improve the care of individuals with kidney disease. The new report features data accumulated through 2019. Along with producing the ADR on end-stage renal disease and chronic kidney disease in the United States, the USRDS fulfills data requests, provides standard analysis files (SAFs) to researchers, produces the Researcher’s Guide to help researchers use USRDS data, and presents the results of its research at national conferences and in peer-reviewed journals. Learn more by visiting the USRDS website.


NIDDK research creates knowledge about and treatments for diseases that are among the most chronic, costly, and consequential for patients, their families, and the nation. Learn more by visiting the NIDDK website.

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