Discrepancy between Medical Evidence Form 2728 and Renal Biopsy for Glomerular Diseases

Layton, J. Bradley; Hogan, Susan L.; Jennette, Caroline E.; Kenderes, Barbara; Krisher, Jenna; Jennette, J. Charles; McClellan, William M.

doi:10.2215/cjn.03550410

Cited by 67 publications

(65 citation statements)

References 21 publications

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“…First, we cannot confirm the validity of GN subtype designations obtained from the USRDS. A previous study measured agreement between biopsy-based diagnoses and USRDS-derived diagnoses among 227 patients with biopsy-proven GN (29). Poor overall agreement was largely explained by missing (57%) and GN not histologically examined (9%) diagnoses submitted to the USRDS; positive predictive values exceeded 90% once a specific GN subtype was selected.…”

Section: Discussionmentioning

confidence: 99%

Patient Characteristics and Outcomes by GN Subtype in ESRD

O’Shaughnessy

Montez‐Rath

Lafayette

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives Outcomes-based research rarely focuses on patients with ESRD caused by GN. The hypotheses were that the GN subtype would clinically discriminate patient groups and independently associate with survival after ESRD therapy initiation.Design, setting, participants, & measurements Data were extracted from the US Renal Data System for adult patients with incident (1996-2011) ESRD attributed to six GN subtypes: FSGS, IgA nephropathy (IgAN), membranous nephropathy, membranoproliferative glomeruonephritis, lupus nephritis (LN), and vasculitis. ESRD attributed to diabetes and autosomal dominant polycystic kidney disease served as non-GN comparators. Unadjusted and adjusted mortality hazard ratios (aHRs) with 95% confidence intervals (95% CIs) were estimated using Cox regression (reference, IgAN). Models sequentially adjusted for sociodemographic (model 2), comorbidity/laboratory (model 3), and ESRD treatment modality (model 4) variables.Results Among 84,301 patients with ESRD attributed to GN, the median age ranged from 39 (LN) to 66 (vasculitis) years, male sex ranged from 18% (LN) to 68% (IgAN), and black race ranged from 7% (IgAN) to 49% (LN). Patients with IgAN had the fewest comorbidities and lowest use of hemodialysis (70.1%). After a median followup of 2.5 (interquartile range, 1.0-4.9) years, crude mortality was lowest in IgAN (3.7 deaths/100 person years). Compared to IgAN, adjusted mortality was highest in LN (model 4 aHR=1.75; 95% CI, 1.68 to 1.83) and in diabetes (aHR=1.73; 95% CI, 1.67 to 1.79), and was also higher in all other GN subtypes (membranous nephropathy: aHR=1.23; 95% CI, 1.17 to 1.29; FSGS: aHR=1.37; 95% CI, 1.32 to 1.42; membranoproliferative GN: aHR=1.38; 95% CI, 1.31 to 1.45; vasculitis: aHR=1.51; 95% CI, 1.45 to 1.58) and in autosomal dominant polycystic kidney disease (aHR=1.22; 95% CI, 1.18 to 1.27).Conclusions This study exposes substantial heterogeneity across GN subtypes at ESRD therapy initiation and identifies independent associations between GN subtype and post-ESRD mortality. These survival discrepancies warrant further study, and the utility of current research practice to group GN subtypes together when evaluating ESRD outcomes should be questioned.

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Section: Discussionmentioning

confidence: 99%

Patient Characteristics and Outcomes by GN Subtype in ESRD

O’Shaughnessy

Montez‐Rath

Lafayette

et al. 2015

Clinical Journal of the American Society of Nephrology

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“…In addition, the use of community-level surrogates for socioeconomic status could introduce information bias. The source of data on medical comorbid conditions was the medical evidence report, which can have inconsistencies and errors, especially when completed by nonphysicians (30). Although every effort was made to reduce the effect of confounding, unmeasured confounders may limit the interpretation of the results.…”

Section: Discussionmentioning

confidence: 99%

Rural and Micropolitan Residence and Mortality in Patients on Dialysis

Maripuri

Arbogast

İkizler

et al. 2012

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Micropolitan and rural patients face challenges when initiating dialysis, including healthcare access. Previous studies have shown little association of nonurban residence with dialysis outcomes but have not examined the association of dialysis modality with residence location.Design, setting, participants, & measurements This retrospective cohort study used data from the U.S. Renal Data System. Adults who initiated maintenance dialysis between January 1, 2006, and December 31, 2007, were classified as rural, micropolitan, or urban. Early and long-term mortality and kidney transplantation were examined with Cox regression stratified by dialysis modality.Results Of 204,463 patients, 80% were urban; 10.2%, micropolitan; and 9.8%, rural. Micropolitan and rural patients were older, were less racially diverse, had more comorbid conditions, and were more likely to start peritoneal dialysis (PD). Median follow-up was 2.0 years. Early mortality or long-term hemodialysis (HD) mortality did not significantly differ by geographic residence. After adjustment, micropolitan and rural PD patients had higher risk for long-term mortality (hazard ratio [HR] Conclusions Micropolitan and rural residence is associated with higher mortality in PD patients and similar or higher likelihood of kidney transplantation among HD and PD patients. Studies examining the underlying mechanisms of these associations are warranted.

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“…Secondary hypertension is a common consequence of longstanding kidney disease. Layton et al (2) further reported that causes of kidney failure were missing in up to 57% of patients.…”

Section: Limitations Of Esrd Classification On the Current Cms 2728 Formmentioning

confidence: 99%

“…Kidney biopsies are typically not performed in patients with longstanding diabetes or individuals without diabetes who lack heavy proteinuria. Surprisingly, even when kidney biopsies are performed, incorrect diagnoses may still be listed (2). This may relate to physicians' lack of awareness that biopsy data exist or that nonmedical personnel completed the form.…”

Section: Limitations Of Esrd Classification On the Current Cms 2728 Formmentioning

confidence: 99%