Impact of a Chronic Kidney Disease Clinic on Preemptive Kidney Transplantation and Transplant Wait Times

Khosla, Neenoo; Gordon, Elisa J.; Nishi, Laura; Ghossein, Cybele

doi:10.1177/152692481002000304

Cited by 13 publications

(10 citation statements)

References 29 publications

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“…Among adults, a growing body of literature has linked delayed referral for pre-ESRD care with worse patient outcomes, including increased risk of mortality (32,33), hospitalization (33,34) and decreased access to renal transplantation (35,36). In addition, both low SES and minority race have been linked with inadequate pre-ESRD care (37–39). In pediatric ESRD, minority race and lack of health insurance are both associated with late start of dialysis and decreased access to specialty care (40).…”

Section: Discussionmentioning

confidence: 99%

Racial Disparities in Pediatric Access to Kidney Transplantation: Does Socioeconomic Status Play a Role?

Patzer

Amaral

Klein

et al. 2012

American Journal of Transplantation

106

104

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Racial disparities persist in access to renal transplantation in the United States, but the degree to which patient and neighborhood socioeconomic status (SES) impacts racial disparities in deceased donor renal transplantation access has not been examined in the pediatric and adolescent end-stage renal disease (ESRD) population. We examined the interplay of race and SES in a population-based cohort of all incident pediatric ESRD patients <21 years from the United States Renal Data System from 2000 to 2008, followed through September 2009. Of 8 452 patients included, 30.8%were black, 27.6% white-Hispanic, 44.3% female and 28.0% lived in poor neighborhoods. A total of 63.4% of the study population was placed on the waiting list and 32.5% received a deceased donor transplant. Racial disparities persisted in transplant even after adjustment for SES, where minorities were less likely to receive a transplant compared to whites, and this disparity was more pronounced among patients 18–20 years. Disparities in access to the waiting list were mitigated in Hispanic patients with private health insurance. Our study suggests that racial disparities in transplant access worsen as pediatric patients transition into young adulthood, and that SES does not explain all of the racial differences in access to kidney transplantation.

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Section: Discussionmentioning

confidence: 99%

Racial Disparities in Pediatric Access to Kidney Transplantation: Does Socioeconomic Status Play a Role?

Patzer

Amaral

Klein

et al. 2012

American Journal of Transplantation

106

104

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“…2005; Pagels et al . 2008; Khosla et al . 2010), with limited studies focused on the delivery of education about CKD in primary care settings (Crinson et al .…”

Section: Discussionmentioning

confidence: 99%

“…2006; Rastogi et al . 2008; Beaulieu & Levin 2009), a majority of US‐based multidisciplinary CKD education programmes have been based primarily within nephrology clinics (Spry 2008; Khosla et al . 2010; Dixon et al .…”

Section: Discussionmentioning

confidence: 99%

Challenges Perceived by Primary Care Providers to Educating Patients About Chronic Kidney Disease

Greer

Crews

Boulware

2012

Journal of Renal Care

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Objective To identify primary care providers’ (PCPs) perceived barriers to educating patients about chronic kidney disease (CKD) during routine clinical visits. Methods We conducted three focus groups of eighteen PCPs in Baltimore, Maryland (MD), USA. Focus groups began with the presentation of a hypothetical case of a patient with CKD, followed by open-ended questions to assess providers’ perceived barriers to delivering education about CKD. Groups were audiotaped, transcribed, and coded independently by two investigators who identified major themes. Results PCPs reported on several patient, provider and system level barriers contributing to poor education about CKD in primary care that were both common and unique to barriers previously reported in educating patients regarding other chronic diseases. Conclusions Interventions designed to address barriers to CKD education identified by PCPs could improve the delivery of education about CKD in primary care settings.

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“…The factors that influence this finding are unknown, but could be related to improved participation in care, better educational resources, or avoidance of blood transfusions through use of erythropoiesis stimulating agents. In addition, pre-ESRD care has been associated with pre-emptive kidney transplantation[24], suggesting quality CKD care could drive referrals to kidney transplant centers. Pre-ESRD care among micropolitan and rural patients associates with kidney transplantation similarly to urban patients, suggesting that receiving care confers a similar benefit regardless of where a patient lives.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of Pre-End-Stage Renal Disease Care and Associated Outcomes among Urban, Micropolitan, and Rural Dialysis Patients

Maripuri

İkizler

Cavanaugh³

2013

Am J Nephrol

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Background/Aims: Pre-end-stage renal disease (ESRD) care is associated with improved outcomes among patients receiving dialysis. It is unknown what proportion of US micropolitan and rural dialysis patients receive pre-ESRD care and benefit from such care when compared to urban. Methods: A retrospective cohort study was performed using data from the US Renal Data System. Patients ≥18 years old who initiated dialysis in 2006 and 2007 were classified as rural, micropolitan or urban and the prevalence of pre-ESRD care (early nephrology care >6 months, permanent vascular access, -dietary education) was determined using the medical evidence report. The association of pre-ESRD care with dialysis mortality and transplantation was assessed using Cox regression with stratification for geographic residence. Results: Of 204,463 dialysis patients, 80% were urban, 10.2% were micropolitan and 9.8% were rural. Overall attainment of pre-ESRD care was poor. After adjustment, there were no significant geographic differences in attainment of early nephrology care or permanent dialysis access. Receiving care reduced all-cause mortality and increased the likelihood of transplantation to a similar degree regardless of geographic residence. Both micropolitan and rural patients received less dietary education (relative risk = 0.80, 95% CI = 0.76-0.84 and relative risk = 0.85, 95% CI = 0.80-0.89, respectively). Conclusion: Among patients who receive dialysis, the prevalence of early nephrology care and permanent dialysis access is poor and does not vary by geographic residence. Micropolitan and rural patients receive less dietary education despite an observed mortality benefit, suggesting that barriers may exist to quality dietary care in more remote locations.

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Impact of a Chronic Kidney Disease Clinic on Preemptive Kidney Transplantation and Transplant Wait Times

Abstract: A chronic kidney disease clinic can influence rates of preemptive kidney transplantation and transplantation referral times.

Cited by 13 publications

References 29 publications

Racial Disparities in Pediatric Access to Kidney Transplantation: Does Socioeconomic Status Play a Role?

Racial Disparities in Pediatric Access to Kidney Transplantation: Does Socioeconomic Status Play a Role?

Challenges Perceived by Primary Care Providers to Educating Patients About Chronic Kidney Disease

Prevalence of Pre-End-Stage Renal Disease Care and Associated Outcomes among Urban, Micropolitan, and Rural Dialysis Patients

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