Frequency of Early Predialysis Nephrology Care and Postdialysis Cardiovascular Events

Predialysis Nephrology Care and Incident Atrial Fibrillation in Older Patients With ESKD Initiating Dialysis

“…Although statistically significant, the associations were of modest magnitude and varied more with the frequency of predialysis nephrology visits rather than duration of outpatient nephrology care. These findings complement recent results from Taiwan, where Yang et al 8 found an adjusted 10% reduction in the time to the earliest among myocardial infarction, hospitalized heart failure, stroke, and sudden death for patients with early and frequent predialysis nephrology care.…”

“…7 Indeed, a recent study from Taiwan found an association of earlier and more frequent nephrology care among patients with advanced chronic kidney disease reaching ESKD with improved cardiovascular outcomes after initiation of dialysis. 8 Among cardiovascular diseases and conditions, arrhythmias such as AF are particularly common 9 and contribute to significant cardiovascular morbidity and mortality. 1 The prevalence of AF among patients with ESKD receiving hemodialysis is 10-to 20-fold higher than that in the general population.…”

National Trends in the Association of Race and Ethnicity With Predialysis Nephrology Care in the United States From 2005 to 2015

“…Receipt of nephrology care before the initiation of treatment for end-stage kidney disease (ESKD) is associated with improved patient survival and other key outcomes, including reduced hospitalizations and complications, increased quality of life, better preparation for dialysis, and greater likelihood of receiving a kidney transplant. 1 , 2 , 3 Primary care clinicians are generally the first to detect chronic kidney disease (CKD) and play key roles in deciding when to refer patients to nephrology care. 4 Current guidelines recommend referral to a nephrologist for patients with an estimated glomerular filtration rate of less than 30 mL/min/1.73 m 2 , severely increased albuminuria, rapid decline of the estimated glomerular filtration rate, hematuria, and/or uncontrolled complications of CKD, such as hypertension requiring 4 or more antihypertensive agents, anemia, or electrolyte abnormalities.…”

Effects of Higher Quality of Care on Initiation of Long-term Dialysis in Patients With CKD and Diabetes

“…The NHI system covers .99% of Taiwan's population and has been in operation since 1995. 7,15 The LHDB is a sub-data set comprising a randomly sampled cohort of deidentified patients with incident diabetes from the NHI Research Database, which is constructed and maintained by the National Health Research Institutes, Taiwan. 16 The LHDB randomly sampled 120,000 patients with incident diabetes each year.…”

“…intervention and toward improving the quality of care for patients with CKD with diabetes. [5][6][7] The quality of health care is often quantified by using quality indicators. However, most established quality indicators for the quality of care of kidney disease focus on outcomes in dialysis patients.…”