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

Brenda W Gillespie; Hal Morgenstern; Elizabeth Hedgeman; Anca Tilea; Natalie Scholz; Tempie Shearon; Nilka Rios Burrows; Vahakn B Shahinian; Jerry Yee; Laura Plantinga; Neil R Powe; William McClellan; Bruce Robinson; Desmond E Williams; Rajiv Saran

doi:10.1093/ckj/sfv103

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

Clin Kidney J. 2015 Dec;8(6):772-80. doi: 10.1093/ckj/sfv103. Epub 2015 Nov 3.

Authors

Affiliations

¹ Kidney Epidemiology and Cost Center , University of Michigan , Ann Arbor, MI , USA ; Department of Biostatistics , University of Michigan , Ann Arbor, MI , USA ; Center for Statistical Consultation and Research, University of Michigan , Ann Arbor, MI , USA.
² Department of Epidemiology , University of Michigan School of Public Health , Ann Arbor, MI , USA ; Department of Environmental Health Sciences , University of Michigan School of Public Health , Ann Arbor, MI , USA ; Department of Urology , University of Michigan Medical School , Ann Arbor, MI , USA.
³ EpidStat Institute , Ann Arbor, MI , USA.
⁴ Kidney Epidemiology and Cost Center , University of Michigan , Ann Arbor, MI , USA ; Department of Internal Medicine , University of Michigan , Ann Arbor, MI , USA.
⁵ Kidney Epidemiology and Cost Center , University of Michigan , Ann Arbor, MI , USA ; Department of Biostatistics , University of Michigan , Ann Arbor, MI , USA.
⁶ Division of Diabetes Translation , Centers for Disease Control and Prevention , Atlanta, GA , USA.
⁷ Henry Ford Health System , Detroit, MI , USA.
⁸ Department of Epidemiology , Emory University , Atlanta, GA , USA.
⁹ Department of Medicine , San Francisco General Hospital and University of California , San Francisco, CA , USA.
¹⁰ Arbor Research Collaborative for Health , Ann Arbor, MI , USA.
¹¹ Kidney Epidemiology and Cost Center , University of Michigan , Ann Arbor, MI , USA ; Department of Epidemiology , University of Michigan School of Public Health , Ann Arbor, MI , USA ; Department of Internal Medicine , University of Michigan , Ann Arbor, MI , USA.

Abstract

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 (R (2) = 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.

Keywords: dialysis; glomerular filtration rate; kidney transplantation; nephrology referral; vascular access.

Abstract

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