Predialysis nephrology care of patients with chronic kidney disease

January 01, 0001

Predialysis nephrology care of patients with chronic kidney disease

Little is known about trends in the timing of first nephrology consultation and associated outcomes among older patients initiating dialysis. These US authors analyzed data from patients aged 67 years or older who initiated dialysis in the United States between January 1996and December 2006, stratified by timing of the earliest identifiable nephrology visit. Trends of earlier nephrology consultation were formally examined in light of concurrently changing case mix and juxtaposed with trends in 1-year mortality rates after initiation of dialysis.

They found: "Among 323,977 older patients initiating dialysis, the proportion of patients receiving nephrology care less than 3 months before initiation of dialysis decreased from 49.6% (in 1996) to 34.7% (in 2006). Patients initiated dialysis with increasingly preserved kidney function, from a mean estimated glomerular filtration rate of 8 mL/min/1.73 m2 in 1996 to 12 mL/min/1.73 m2 in 2006. Patients were less anemic in later years, which was partly attributable to increased use of erythropoiesis-stimulating agents, and fewer used peritoneal dialysis as the initial modality. During the same period, crude 1-year mortality rates remained unchanged. Adjustment for changes in demographic and comorbidity patterns yielded estimated annual reductions in 1-year mortality rates of 0.9%, which were explained only partly by concurrent trends toward earlier nephrology consultation (annual mortality reduction after accounting for timing of nephrology care was attenuated to 0.4%."

The authors concluded: "Despite significant trends toward earlier use of nephrology consultation among older patients approaching maintenance dialysis, we observed no material improvement in 1-year survival rates after dialysis initiation during the same time period."

There is no proven benefit of early nephrology consultation for patients with chronic kidney disease.

For the full abstract, click here.

Arch Intern Med 171(15):1371-1378, 8/22 August 2011 © 2011 to the American Medical Association
Predialysis Nephrology Care of Older Patients Approaching End-stage Renal Disease. Wolfgang C. Winkelmayer, Jun Liu, Glenn M. Chertow, Manjula Kurella Tamura. Correspondence to Dr. Winkelmayer: [email protected]

Category: U. Urinary, HSR. Health Services Research. Keywords: chronic kidney disease, older patients, end-stage renal disease, nephrology consultation, hemodialysis, outcomes research, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 16 August 2011

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.

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