Nephrology care prior to end-stage renal disease and outcomes among new ESRD patients in the USA

Details

• Alternative Title:
  Clin Kidney J
• Personal Author:
  Gillespie, Brenda W. ; Morgenstern, Hal ; Hedgeman, Elizabeth ; Tilea, Anca ; Scholz, Natalie ; Shearon, Tempie ; Burrows, Nilka Rios ; Shahinian, Vahakn B. ; Yee, Jerry ; Plantinga, Laura ; Powe, Neil R. ; McClellan, William ; Robinson, Bruce ; Williams, Desmond E. ; Saran, Rajiv
• Description:
  Background
  
  Longer nephrology care before end-stage renal disease (ESRD) has been linked with better outcomes.
  
  Methods
  
  We investigated whether longer pre-end-stage renal disease (ESRD) nephrology care was associated with lower mortality at both the patient and state levels among 443 761 incident ESRD patients identified in the USA between 2006 and 2010.
  
  Results
  
  Overall, 33% of new ESRD patients had received no prior nephrology care, while 28% had received care for >12 months. At the patient level, predictors of >12 months of nephrology care included having health insurance, white race, younger age, diabetes, hypertension and US region. Longer pre-ESRD nephrology care was associated with lower first-year mortality (adjusted hazard ratio = 0.58 for >12 months versus no care; 95% confidence interval 0.57–0.59), higher albumin and hemoglobin, choice of peritoneal dialysis and native fistula and discussion of transplantation options. Living in a state with a 10% higher proportion of patients receiving >12 months of pre-ESRD care was associated with a 9.3% lower relative mortality rate, standardized for case mix (R2 = 0.47; P < 0.001).
  
  Conclusions
  
  This study represents the largest cohort of incident ESRD patients to date. Although we did not follow patients before ESRD onset, our findings, both at the individual patient and state levels, reflect the importance of early nephrology care among those with chronic kidney disease.
  
  
• Subjects:
  Contents Dialysis Glomerular Filtration Rate Kidney Transplantation Nephrology Referral Vascular Access
• Source:
  Clin Kidney J. 2015; 8(6):772-780.
• Pubmed ID:
  26613038
• Pubmed Central ID:
  PMC4655805
• Document Type:
  Journal Article
• Volume:
  8
• Issue:
  6
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:d163482af874412d59bc64470fada9afbfb08d76856f16d3578020380dc02cf8
• Download URL:
  https://stacks.cdc.gov/view/cdc/36167/cdc_36167_DS1.pdf
• File Type:
  [PDF - 600.52 KB ]