대한신장학회

논문분류	춘계학술대회 초록집
제목	Impact of the COVID-19 Pandemic on Emergency Department Utilization and Outcomes in Patients with End-stage Kidney Disease: A Retrospective Cohort Study in South Korea
저자	Hyunjin Cho
출판정보	2026; 2026(1):
키워드	End-stage kidney disease, COVID-19 pandemic, Emergency medical service
초록	Objectives: Patients with end-stage kidney disease (ESKD) are clinically vulnerable and experience high rates of emergency department (ED) visits, hospitalization, and mortality. We aimed to evaluate temporal changes in ED utilization and clinical outcomes among patients with ESKD in South Korea before and during the COVID-19 pandemic using nationwide data. Methods: We conducted a nationwide retrospective cohort study using data from the National Emergency Department Information System (NEDIS) between January 1, 2018, and December 31, 2021. Adult patients (≥20 years) with ESKD who visited the ED were included and categorized into pre–COVID-19 (2018–2019) and COVID-19 (2020–2021) periods. Baseline characteristics, ED visit frequency, presenting causes, and clinical severity were compared between the two periods. Hospitalization and in-hospital mortality were analyzed according to the Korean Triage and Acuity Scale (KTAS) classification using multivariable logistic regression. Results: A total of 159,456 ESKD-related ED visits were analyzed (76,277 in 2018–2019; 83,179 in 2020–2021) (Figure 1). The frequency and clinical severity of ESKD-related ED visits increased significantly during the COVID-19 period compared with the pre-COVID-19 period, with a higher proportion of patients aged ≥80 years. These visits were associated with higher odds of hospitalization (adjusted odds ratio [aOR], 1.054; 95% confidence interval [CI], 1.031–1.079) and mortality (aOR, 1.052; 95% CI, 1.007–1.099). This trend was most prominent in patients with high clinical severity (KTAS 1-3; Figure 2). Moreover, high-severity patients more frequently utilized high-level hospitals and had higher hospitalization and mortality rates. Vascular access complications were the leading cause of ED visits. Conclusion: The pandemic imposed an increased clinical burden on patients with ESKD. However, our findings suggest that South Korea’s tiered Emergency Medical System maintained functional resilience during the pandemic. These findings may inform preparedness strategies for managing vulnerable populations, such as patients with ESKD, during future public health crises.
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