Impacts of COVID-19 pandemic on kidney biopsy research, practice, and diagnoses: A cross-sectional audit

The impact of the coronavirus disease 2019 (COVID-19) pandemic extended beyond direct infection-associated complications to wide-reaching impacts on health system including workflow disruption, enhanced telehealth utilization, labor force changes, and access to procedures. Whilst it is clear that COVID-19 can affect histopathological findings on kidney biopsy, the impact of COVID-19 pandemic on non-COVID-19 kidney disease research remains unclear. This study reviewed kidney biopsy research activity (i.e., patient consent and bio-sample collection), kidney biopsy practice and histopathological findings over the COVID-19 pandemic in an Australian metropolitan health service network of 4 hospitals between 2018 and 2023. All kidney biopsies performed at the Metro North Kidney Health Service between 2018 and 2023 were divided into pre-pandemic (2018-2019), pandemic (2020-2021) and post-pandemic (2022-2023) eras. Demographic data, consent rates, bio-sample collection rates, and procedural complications were retrospectively compared between the 3 eras. Two hundred twenty-nine kidney biopsies were performed in 2018 to 2019, 223 in 2020 to2021 and 213 in 2022 to 2023. Participant consent for research reduced from 70% to 63% between pre-pandemic to pandemic eras but quickly recovered in the post-pandemic era (68%). Bio-sample collection decreased (pre-pandemic: 50%, pandemic: 47%, post-pandemic: 38%) and did not recover in the post-pandemic era indicating the long tail effect on research activities. Although there were changes in service provision (e.g., delay in elective procedures, lockdowns), these measures were not associated with changes in biopsy number, setting, and department over the course of the pandemic. Kidney disease biomarker research activities decreased during the COVID-19 pandemic as demonstrated by reductions in biomarker study consent and sample collection. Strategies to maintain non-pandemic research need to be built into pandemic preparedness plans to preserve the momentum of discoveries which improve clinical outcomes for non-pandemic diseases; discoveries which may well end up being repurposed for pandemic-related conditions (e.g., remdesivir from Ebola research).