TY - JOUR
T1 - Nephrology care prior to end-stage renal disease and outcomes among new ESRD patients in the USA
AU - Gillespie, Brenda W.
AU - Morgenstern, Hal
AU - Hedgeman, Elizabeth
AU - Tilea, Anca
AU - Scholz, Natalie
AU - Shearon, Tempie
AU - Burrows, Nilka Rios
AU - Shahinian, Vahakn B.
AU - Yee, Jerry
AU - Plantinga, Laura
AU - Powe, Neil R.
AU - McClellan, William
AU - Robinson, Bruce
AU - Williams, Desmond E.
AU - Saran, Rajiv
N1 - Publisher Copyright:
© 2015 The Author.
PY - 2015/12
Y1 - 2015/12
N2 - 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 carewas 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.
AB - 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 carewas 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.
KW - Dialysis
KW - Glomerular filtration rate
KW - Kidney transplantation
KW - Nephrology referral
KW - Vascular access
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U2 - 10.1093/ckj/sfv103
DO - 10.1093/ckj/sfv103
M3 - Article
C2 - 26613038
AN - SCOPUS:84959376484
SN - 2048-8505
VL - 8
SP - 772
EP - 780
JO - Clinical Kidney Journal
JF - Clinical Kidney Journal
IS - 6
ER -