Nephrologist care for 12 months or more increases hemodialysis initiation with permanent vascular access

Inaguma, Daijo; Ando, Ryoichi; Ikeda, Masato; Joki, Nobuhiko; Koiwa, Fumihiko; Komatsu, Yasuhiro; Sakaguchi, Toshihumi; Shinoda, Takeshi; Yamaka, Toshihiko; Sügimura, Takashi

doi:10.1007/s10157-011-0472-7

Cited by 9 publications

(6 citation statements)

References 16 publications

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“…Numerous studies indicated the importance of early referral to a nephrologist. In particular, these studies reported an association between late referral for CKD care and adverse outcomes, such as choice of dialysis modality [ 4 , 5 ], inpatient start or emergent initiation of renal replacement therapy [ 4 , 6 ], use of a hemodialysis catheter [ 6 , 7 ], and mortality [ 6 , 8 , 9 ]. Other studies reported that the advantages of early referral are provision of appropriate therapy based on diagnosis, slowing or arresting the progression of CKD, prevention and management of comorbid conditions and CKD-specific complications, planning and preparation for maintenance dialysis, and psychosocial support[ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Pre-Dialysis Visits to a Nephrology Department and Major Cardiovascular Events in Patients Undergoing Dialysis

et al. 2016

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Background and ObjectivesPre-dialysis care by a nephrology out-patient department (OPD) may affect the outcomes of patients who ultimately undergo maintenance dialysis. This study examined the effect of pre-dialysis care by a nephrology OPD on the incidence of one-year major cardiovascular events after initiation of dialysis.Design, Setting Participants, & MeasurementsThe study consisted of Taiwanese patients with chronic kidney disease (CKD) who commenced dialysis from 2006 to 2008. The number of nephrology OPD visits during the critical care period (within 6 months of initiation of dialysis) and the early care period (6–36 months before initiation of dialysis) were analyzed. The primary outcome measure was one-year major cardiovascular events.ResultsA total of 1191 CKD patients who initiated dialysis from 2006 to 2008 were included. Binary logistic regression showed that patients with ≧3 visits during the critical care period and those with ≧11 visits during the early care period had fewer composite major cardiovascular events than those with 0 visits. Patients with early referral are less likely to experience composite major cardiovascular events than those with late referral, with aOR 0.574 (95% CI = 0.43–0.77, P<0.001). Patients with both ≧3 visits during critical care period and ≧11 visits during early care period were less likely to experience composite major cardiovascular events (aOR = 0.25, 95% CI = 0.16–0.39, P < 0.001).ConclusionsPatients with adequate pre-dialysis nephrology OPD visits, not just early referral, may had fewer one-year composite major cardiovascular events after initiation of dialysis. This information may be important to medical care providers and public health policy makers in their efforts to improve the well-being of CKD patients.

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Section: Introductionmentioning

confidence: 99%

Pre-Dialysis Visits to a Nephrology Department and Major Cardiovascular Events in Patients Undergoing Dialysis

et al. 2016

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“…In fact, despite the enormous disparity in nephrologists per capita, rural patients are significantly more likely to have a functional AVF at first outpatient dialysis. This finding was seen despite the lack of significant differences in pre-ESRD nephrology care, which in other studies has been associated with increased placement of AVFs (15). Curiously, other factors associated with improved AVF placement were greater availability of nephrologists and surgeons for a given population (16), along with coordinated care (17), a factor not discernible from the database.…”

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confidence: 67%

Making the Crooked Way Straight

Abbott

Nee

Yuan

2013

Clinical Journal of the American Society of Nephrology

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“…The successful creation and use of an AVF requires a coordinated multidisciplinary team of nephrologists, nurses, surgeons, the patient, and the patient's family. Referral to a nephrologist close to the time of initiation of dialysis is a common reason for lower AVF use because it does not allow for sufficient time to complete the required planning and preparation . Although the incidence of CKD has increased gradually in China, there is low awareness and insufficient treatment due to medical costs.…”

Section: Discussionmentioning

confidence: 99%

“…In China, AVFs are only used in approximately 20% of incident patients prior to hemodialysis, whereas approximately 80% of patients with chronic kidney disease (CKD) are initiated with a CVC . High rates of AVF use are possibly a result of early referrals to nephrologists . In addition, many patients do not receive follow up due to insufficient awareness of the disease and the high cost of doctor's visits.…”

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confidence: 99%

Analysis of Follow‐Up Methods of Vascular Access and Patient Outcomes in Hemodialysis at a Tertiary Care Hospital in China

et al. 2018

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Arteriovenous fistula is the preferred option for vascular access in hemodialysis patients. The aim of this study was to assess different follow-up methods for hemodialysis patients in our hemodialysis center in China. A cohort of 124 patients with stage 3 chronic kidney disease was recruited and double-blind randomly assigned into two groups. Patients in Group A received phone calls to schedule their next consultation a week in advance. Patients in Group B scheduled their next appointment at the end of each visit. A total of 116 patients were included in the study and eight dropped out. Twenty-seven patients (46.4%) in Group A and 13 patients (22.4%) in Group B had an AVF prior to hemodialysis (P = 0.006), and 44.8% of patients in Group A and 15.5% of patients in Group B were using AVFs at the initiation of dialysis (P = 0.003). Sixteen patients (27.6%) in Group A and 24 patients (41.3%) in Group B required central venous catheters due to acute on chronic kidney disease and 13 patients (22.4%) in Group A and 21 patients (36.2%) in Group B required central venous catheters due to patient-related delays (P = 0.02). At the end of the study, seven patients in Group A died and 17 patients in Group B died (P = 0.027). The patients who received phone calls to schedule appointments in advance had a higher rate of arteriovenous fistulas prior to dialysis and at hemodialysis initiation had a reduced incidence of acute on chronic kidney disease and patient-related delays, and had an improved prognosis.

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Nephrologist care for 12 months or more increases hemodialysis initiation with permanent vascular access

Abstract: Early referral was shown to be advantageous for increasing the likelihood of availability of a permanent VA, even after patients who had been followed up for less than 3 months by nephrologists were excluded.

Cited by 9 publications

References 16 publications

Pre-Dialysis Visits to a Nephrology Department and Major Cardiovascular Events in Patients Undergoing Dialysis

Pre-Dialysis Visits to a Nephrology Department and Major Cardiovascular Events in Patients Undergoing Dialysis

Making the Crooked Way Straight

Analysis of Follow‐Up Methods of Vascular Access and Patient Outcomes in Hemodialysis at a Tertiary Care Hospital in China

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