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

• Type of Material: Article
• Authors: Brenda W. Gillespie, University of Michigan; Hal Morgenstern, University of Michigan; Elizabeth Hedgeman, EpidStat Institute; Anca Tilea, University of Michigan; Natalie Scholz, University of Michigan; Tempie Shearon, University of Michigan; Nilka Rios Burrows, Centers for Disease Control and Prevention; Vahakn B. Shahinian, University of Michigan; Jerry Yee, Henry Ford Health System; Laura Plantinga, Emory University; Neil R. Powe, University of California, San Francisco; William McClellan, Emory University; Bruce Robinson, Arbor Research Collaborative for Health; Desmond E. Williams, Centers for Disease Control and Prevention; Rajiv Saran, University of Michigan
• Language: English
• Date: 2015-12
• Publisher: Oxford University Press (OUP): Policy C - Option B
• Publication Version: Final Published Version
• Copyright Statement: © The Author 2015.
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1093/ckj/sfv103
• Title of Journal or Parent Work: Clinical Kidney Journal
• ISSN: 2048-8505
• Volume: 8
• Issue: 6
• Start Page: 772
• End Page: 780
• Grant/Funding Information: Support for this work was also provided under a cooperative agreement from the Centers for Disease Control and Prevention (CDC) through grant numbers 5U36CD319276 and 5U58DP003836-04.; This study was supported through grants from the Centers for Medicare & Medicaid Services, CMS contract numbers HHSM-500-2006-00042C and HHSM-500-2011-00091C.
• Keywords: glomerular filtration rate; kidney transplantation; dialysis; nephrology referral; vascular access
• Research Categories: Health Sciences, Epidemiology; Health Sciences, Medicine and Surgery

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 (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.