The COVID-19 pandemic and access to health care in people with chronic kidney disease: A systematic review and meta-analysis.

Abstract

This systematic review aims to evaluate the effect of the COVID-19 pandemic on access to health care for patients with CKD. MEDLINE and EMBASE databases were searched up to July 2021 (PROSPERO CRD42021230831). Data relevant to access to health care before and during the COVID-19 pandemic were extracted, including outcomes related to access to general nephrology consultations, telehealth, dialysis services and kidney transplantations. Relative and absolute effects were pooled using a random effects model to account for between-study heterogeneity. Risk of bias was assessed using a modified Quality in Prognostic Studies tool. The certainty of the evidence was rated using the GRADE approach. Twenty-three studies across five WHO regions were identified. Reductions in transplantation surgeries were observed during the COVID-19 pandemic compared with the pre-COVID-19 era (risk ratio=2.15, 95%CI=1.51-3.06, I2 = 90%, p< .001). Additionally, six studies reported increased use of telehealth services compared with pre-COVID-19 times. Four studies found reduced access to in-person general nephrology services and six studies reported interruptions to dialysis services during the COVID-19 pandemic. Our findings suggest COVID-19 pandemic may have led to reductions in access to kidney transplantation, dialysis and in-person nephrology care. Meanwhile, whilst the use of telehealth has emerged as a promising alternate mode of health care delivery, its utility during the pandemic warrants further investigation. This study has highlighted major barriers to accessing care in a highly vulnerable chronic disease group.