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Impact of timing of nephrology referral and pre-ESRD care on mortality risk among new ESRD patients in the United States.
Am J Kidney Dis. 2003 Feb; 41(2):310-8.AJ

Abstract

BACKGROUND

Recent studies have suggested that early predialysis nephrological care is associated with lower mortality; however, this hypothesis has not been tested in a population-based study. We evaluated the impact of early nephrology referral and pre-end-stage renal disease (ESRD) care on mortality risk in a national cohort of new patients starting dialysis therapy in 1996 and 1997.

METHODS

Data were obtained on a subset of patients (n = 2,264; 56%) from the Dialysis Morbidity and Mortality Study Wave 2 who then were followed up for up to 2 years. Survival comparisons were made using log-rank test, then by Cox regression adjusting for demographics, comorbid medical conditions, and surrogate markers of pre-ESRD care.

RESULTS

Adjusted mortality risks (relative risks [RRs]) were higher for late- (within 4 months of dialysis initiation) compared with early-referred patients at the end of 1 and 2 years of follow-up (RR, 1.68; confidence interval [CI], 1.31 to 2.15; RR, 1.23; CI, 1.02 to 1.47, respectively). Mortality risks were similarly high for the late-referred nondiabetic (RR, 2.10; CI, 1.49 to 2.94) and hemodialysis subgroups (RR, 1.72; CI, 1.25 to 2.38). Conversely, mortality risks were lower for patients who saw a nephrologist at least twice in the year before dialysis therapy initiation (RR, 0.80; CI, 0.62 to 1.03; P = 0.08] compared with those who did not.

CONCLUSION

Late nephrology referral is associated with greater death risk in new patients with ESRD, and more frequent pre-ESRD care confers increased survival benefit. These findings stress the need for earlier referral of patients to nephrologists and improved pre-ESRD care for all patients approaching ESRD in the United States to improve survival. Am J Kidney Dis 41:310-318.

Authors+Show Affiliations

Department of Internal Medicine, Division of Renal Diseases and Hypertension, University of Texas Medical School-Houston, TX, 77030, USA. austin.stack@uth.tmc.edu .

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

12552491

Citation

Stack, Austin G.. "Impact of Timing of Nephrology Referral and pre-ESRD Care On Mortality Risk Among New ESRD Patients in the United States." American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, vol. 41, no. 2, 2003, pp. 310-8.
Stack AG. Impact of timing of nephrology referral and pre-ESRD care on mortality risk among new ESRD patients in the United States. Am J Kidney Dis. 2003;41(2):310-8.
Stack, A. G. (2003). Impact of timing of nephrology referral and pre-ESRD care on mortality risk among new ESRD patients in the United States. American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, 41(2), 310-8.
Stack AG. Impact of Timing of Nephrology Referral and pre-ESRD Care On Mortality Risk Among New ESRD Patients in the United States. Am J Kidney Dis. 2003;41(2):310-8. PubMed PMID: 12552491.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impact of timing of nephrology referral and pre-ESRD care on mortality risk among new ESRD patients in the United States. A1 - Stack,Austin G, PY - 2003/1/29/pubmed PY - 2003/2/15/medline PY - 2003/1/29/entrez SP - 310 EP - 8 JF - American journal of kidney diseases : the official journal of the National Kidney Foundation JO - Am J Kidney Dis VL - 41 IS - 2 N2 - BACKGROUND: Recent studies have suggested that early predialysis nephrological care is associated with lower mortality; however, this hypothesis has not been tested in a population-based study. We evaluated the impact of early nephrology referral and pre-end-stage renal disease (ESRD) care on mortality risk in a national cohort of new patients starting dialysis therapy in 1996 and 1997. METHODS: Data were obtained on a subset of patients (n = 2,264; 56%) from the Dialysis Morbidity and Mortality Study Wave 2 who then were followed up for up to 2 years. Survival comparisons were made using log-rank test, then by Cox regression adjusting for demographics, comorbid medical conditions, and surrogate markers of pre-ESRD care. RESULTS: Adjusted mortality risks (relative risks [RRs]) were higher for late- (within 4 months of dialysis initiation) compared with early-referred patients at the end of 1 and 2 years of follow-up (RR, 1.68; confidence interval [CI], 1.31 to 2.15; RR, 1.23; CI, 1.02 to 1.47, respectively). Mortality risks were similarly high for the late-referred nondiabetic (RR, 2.10; CI, 1.49 to 2.94) and hemodialysis subgroups (RR, 1.72; CI, 1.25 to 2.38). Conversely, mortality risks were lower for patients who saw a nephrologist at least twice in the year before dialysis therapy initiation (RR, 0.80; CI, 0.62 to 1.03; P = 0.08] compared with those who did not. CONCLUSION: Late nephrology referral is associated with greater death risk in new patients with ESRD, and more frequent pre-ESRD care confers increased survival benefit. These findings stress the need for earlier referral of patients to nephrologists and improved pre-ESRD care for all patients approaching ESRD in the United States to improve survival. Am J Kidney Dis 41:310-318. SN - 1523-6838 UR - https://www.unboundmedicine.com/medline/citation/12552491/Impact_of_timing_of_nephrology_referral_and_pre_ESRD_care_on_mortality_risk_among_new_ESRD_patients_in_the_United_States_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0272638602691401 DB - PRIME DP - Unbound Medicine ER -