Late diagnosis of chronic renal failure and mortality on maintenance dialysis

Sesso, Ricardo; Belasco, Angélica Gonçalves Silva

doi:10.1093/oxfordjournals.ndt.a027207

Cited by 166 publications

(107 citation statements)

References 5 publications

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“…The findings of the present study differ from those of previous observational cohort studies, which suggested that early dialysis commencement was associated with important clinical benefits (21)(22)(23)(24)(25)(26)(27)(28). For example, in the CANUSA study (29), the 2-year survival of PD patients with a measured weekly GFR of at least 38 L (average of urinary urea and creatinine clearances) at dialysis commencement was significantly superior to that of PD patients with a measured weekly GFR of less than 38 L (82.1% vs 73.6%, p = 0.01).…”

Section: Johnson Et Alcontrasting

confidence: 99%

Effect of Timing of Dialysis Commencement on Clinical Outcomes of Patients with Planned Initiation of Peritoneal Dialysis in the Ideal Trial

et al. 2012

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ORIGINAL ARTICLES♦ Background: Since the mid-1990s, early dialysis initiation has dramatically increased in many countries. The Initiating Dialysis Early and Late (IDEAL) study demonstrated that, compared with late initiation, planned early initiation of dialysis was associated with comparable clinical outcomes and increased health care costs. Because residual renal function is a key determinant of outcome and is better preserved with peritoneal dialysis (PD), the present prespecified subgroup analysis of the IDEAL trial examined the effects of early-compared with late-start dialysis on clinical outcomes in patients whose planned therapy at the time of randomization was PD.

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Section: Johnson Et Alcontrasting

confidence: 99%

Effect of Timing of Dialysis Commencement on Clinical Outcomes of Patients with Planned Initiation of Peritoneal Dialysis in the Ideal Trial

et al. 2012

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“…It has been reported that residual renal function and serum albumin are both important predictors for patient survival (26)(27)(28)(29)(30). On the other hand, our urgentstart patients were also younger, and so the risk of death was partly offset.…”

Section: Discussionmentioning

confidence: 80%

Impact of Break-In Period on the Short-Term Outcomes of Patients Started on Peritoneal Dialysis

et al. 2014

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♦ Objectives: Peritoneal dialysis (PD) is one of the firstline modalities of renal replacement therapy in patients with end-stage renal disease. Guidelines recommended a break-in period of at least 2 weeks before full PD start. However, the optimal duration of the break-in period is still unclear. In the present study, we investigated the effect of various break-in periods on short-term outcomes in patients on PD.

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“…Data from multiple international studies have shown that delayed referral to a nephrologist is a significant problem and is associated with a higher prevalence of uremic complications at the initiation of dialysis, with increased hospitalization and higher cost of care. [21][22][23][24] In addition, Arora and colleagues demonstrated that incident dialysis patients who were referred late (defined as the first encounter with a nephrologist occurring within 4 months of dialysis initiation) were significantly more likely to have hypoalbuminemia and hypocalcemia and less likely to have received EPO and a permanent vascular access before the first hemodialysis. Late referrals to a nephrologist were also associated with lower levels of renal function at dialysis initiation, as documented by higher serum creatinine and a higher proportion of patients with predicted glomerular filtration rate <5 mL/min per 1.73 m 2 .…”

Section: O R I G I N a L R E S E A R C Hmentioning

confidence: 99%

Examination of Resource Use and Clinical Interventions Associated With Chronic Kidney Disease in a Managed Care Population

London¹,

Solis²,

Goldberg³

et al. 2003

JMCP

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BACKGROUND: The management of chronic kidney disease (CKD) is multifaceted, including monitoring, early diagnosis, and treatment of comorbidities such as diabetes, hypoalbuminemia, and anemia, and initiating timely procedures in preparation for dialysis such as vascular access placement. Presumably, optimal care provided to patients during the predialysis phase will produce a significant impact on morbidity and mortality outcomes.OBJECTIVE: A retrospective analysis was conducted to assess specific factors that may be associated with optimal quality of care for CKD patients during the predialysis phase.METHODS: Health care resource utilization and the occurrence of interventions associated with optimal predialysis care were evaluated with claims data. Predialysis erythropoietin (EPO) therapy, nephrology referrals, and nutritional supplement administration were all examined during the 12 months prior to dialysis.RESULTS: Medical and pharmacy claims from a managed care database were analyzed for 1,936 incident dialysis patients. Of these, 48.7% did not have any interventions associated with optimal care. Only a minority of patients received prescription iron preparations (6.8%), vitamin D (4.0%), and phosphate binders (7.7%). A total of 20.8% patients had a vascular access placement, and 29.8% were in the care of a nephrologist during this same time period. Only 10.5% received predialysis EPO, yet more than 40% were diagnosed with anemia. Of the EPO users, however, 72.4% were also receiving other interventions to appropriately manage CKD.CONCLUSION: These claims-documented results suggest that the lack of EPO use in predialysis patients in a managed care plan may predict overall suboptimal treatment of these patients. There is an apparent need for the proactive management of CKD in a managed care plan to potentially redistribute or reduce health care resource utilization while improving patient outcomes.

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Late diagnosis of chronic renal failure and mortality on maintenance dialysis

Cited by 166 publications

References 5 publications

Effect of Timing of Dialysis Commencement on Clinical Outcomes of Patients with Planned Initiation of Peritoneal Dialysis in the Ideal Trial

Effect of Timing of Dialysis Commencement on Clinical Outcomes of Patients with Planned Initiation of Peritoneal Dialysis in the Ideal Trial

Impact of Break-In Period on the Short-Term Outcomes of Patients Started on Peritoneal Dialysis

Examination of Resource Use and Clinical Interventions Associated With Chronic Kidney Disease in a Managed Care Population

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