Nephrology care prior to end-stage renal disease and outcomes among new ESRD patients in the USA

Gillespie, Brenda W.; Morgenstern, Hal; Hedgeman, Elizabeth; Tilea, Anca; Scholz, N.; Shearon, Tempie H.; Burrows, Nilka Ríos; Shahinian, Vahakn B.; Yee, Jerry; Plantinga, Laura C.; Powe, Neil R.; McClellan, William M.; Robinson, Bruce M.; Williams, Desmond E.; Saran, Rajiv

doi:10.1093/ckj/sfv103

Cited by 83 publications

(80 citation statements)

References 34 publications

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“…It is plausible that clinical and process-of-care factors prior to ESRD may continue to play a role in determining survival after chronic hemodialysis ensues. For instance, it is known that pre-ESRD nephrology care is associated with better survival and prospects for transplantation after incident dialysis [11, 12]. We believe the findings from our study are significant and clinically relevant and can guide health care providers to recognize patients with history of pre-ESRD AKI events.…”

Section: Discussionmentioning

confidence: 60%

“…Morbidity, mortality, and costs of care are among the highest during the transition from CKD to ESRD, and into the first year of dialysis care [10]. This observation suggests that health events during the pre-ESRD period may continue to play a critical role in determining clinical outcomes after initiation of dialysis [11-13]. Although clinical outcomes of AKI have been well studied, the impact of pre-ESRD AKI events on health outcomes after initiation of ESRD care, such as arteriovenous access use at hemodialysis initiation, is not known.…”

Section: Introductionmentioning

confidence: 99%

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Acute Kidney Injury before Dialysis Initiation Predicts Adverse Outcomes in Hemodialysis Patients

et al. 2018

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Background: Acute kidney injury (AKI) is associated with increased morbidity and mortality. Mortality in end-stage renal disease (ESRD) patients is highest during the first year of dialysis. The impact of pre-ESRD AKI events on long-term outcomes in incident ESRD patients remains unknown. Methods: We evaluated a retrospective cohort of 47,341 incident hemodialysis patients from the United States Renal Data System with linked Medicare data for at least 2 years prior to hemodialysis initiation. We examined the impact of pre-ESRD AKI events in the 2-year pre-ESRD period on the type of vascular access used at hemodialysis initiation (central venous catheter (CVC) versus arteriovenous access), and 1-year all-cause mortality after initiating hemodialysis. Results: The mean age was 72 ± 11 years. Of the study cohort, 18% initiated hemodialysis with arteriovenous access, and 54% of patients had at least one pre-ESRD AKI event. One-year, all-cause mortality was 32%. Compared to 75% for patients without a pre-ESRD AKI event, 89% of patients with a pre-ESRD AKI event initiated hemodialysis with CVC than arteriovenous access (p < 0.001). A pre-ESRD AKI event was associated with lower adjusted odds of starting hemodialysis with an arteriovenous access (OR 0.47; 95% CI 0.44–0.50, p < 0.001), and higher adjusted odds of 1-year mortality (OR 1.36; 95% CI 1.30–1.42, p < 0.001). Conclusion: An AKI event prior to initiating hemodialysis independently increases the risk of CVC use and predicts 1-year mortality. Improving processes of care after AKI events may improve dialysis outcomes in patients who progress to ESRD.

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Section: Discussionmentioning

confidence: 60%

Section: Introductionmentioning

confidence: 99%

Acute Kidney Injury before Dialysis Initiation Predicts Adverse Outcomes in Hemodialysis Patients

et al. 2018

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“…These findings suggest that salutary factors associated with pre-ESRD nephrology care and permanent arteriovenous access may possibly contribute to lower mortality rates among MHS patients during the 12 months after dialysis initiation. Prior studies have consistently found a significant inverse association between adequacy of pre-ESRD nephrology care and early mortality among incident dialysis patients [6,14,16,34,36,37]. Gillespie et al [16] found that pre-ESRD nephrology care for >12 months was significantly associated with initial AVF or graft use vs. catheter (aOR 11.3).…”

Section: Discussionmentioning

confidence: 99%

“…Prior studies have consistently found a significant inverse association between adequacy of pre-ESRD nephrology care and early mortality among incident dialysis patients [6,14,16,34,36,37]. Gillespie et al [16] found that pre-ESRD nephrology care for >12 months was significantly associated with initial AVF or graft use vs. catheter (aOR 11.3). Further, Chan et al [3] observed a 61% reduction in early death risk in those patients who initiated dialysis with an AVF, consistent with many studies demonstrating lower morbidity and mortality associated with AVF vs. catheter use [18,19,20,21,22,23,24,25,38,39].…”

Section: Discussionmentioning

confidence: 99%

“…Multiple studies have supported the importance of early nephrology referral and pre-ESRD care in reducing mortality after dialysis initiation, especially during the first year on dialysis [6,7,8,9,10,11,12,13,14,15,16]. One of the primary focuses of pre-ESRD care is the creation of an arteriovenous fistula (AVF), as recommended by the Kidney Disease Improving Global Outcomes to be the vascular access of choice for patients needing maintenance HD [17] due to its longevity and lower rates of infection and intervention.…”

Section: Introductionmentioning

confidence: 99%

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Pre-End-Stage Renal Disease Care and Early Survival among Incident Dialysis Patients in the US Military Health System

Nee¹,

Fisher²,

Yuan³

et al. 2017

Am J Nephrol

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Background: Previous reports showed an increased early mortality after chronic dialysis initiation among the end-stage renal disease (ESRD) population. We hypothesized that ESRD patients in the Military Health System (MHS) would have greater access to pre-ESRD care and hence better survival rates during this early high-risk period. Methods: In this retrospective cohort study, using the US Renal Data System database, we identified 1,256,640 patients initiated on chronic dialysis from January 2, 2004 through December 31, 2014, from which a bootstrap sample of 3,984 non-MHS incident dialysis patients were compared with 996 MHS patients. We assessed care by a nephrologist and dietitian, erythropoietin administration, and vascular access use at dialysis initiation as well as all-cause mortality as outcome variables. Results: MHS patients were significantly more likely to have had pre-ESRD nephrology care (adjusted OR [aOR] 2.9; 95% CI 2.3-3.7) and arteriovenous fistula used at dialysis initiation (aOR 2.2; 95% CI 1.7-2.7). Crude mortality rates peaked between the 4th and the 8th week for both cohorts but were reduced among MHS patients. The baseline adjusted Cox model showed significantly lower death rates among MHS vs. non-MHS patients at 6, 9, and 12 months. This survival advantage among MHS patients was attenuated after further adjustment for pre-ESRD nephrology care and dialysis vascular access. Conclusions: MHS patients had improved survival within the first 12 months compared to the general ESRD population, which may be explained in part by differences in pre-ESRD nephrology care and vascular access types.

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Risk of Cardiovascular Disease and Mortality in Young Adults With End-stage Renal Disease

Modi

et al. 2019

JAMA Cardiol

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IMPORTANCE Cardiovascular disease (CVD) is a leading cause of death among patients with end-stage renal disease (ESRD). Young adult (ages 22-29 years) have risks for ESRD-associated CVD that may vary from other ages. OBJECTIVE To test the hypothesis that young adult-onset ESRD is associated with higher cardiovascular (CV) hospitalizations and mortality with different characteristics than childhood-onset disease. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study used the US Renal Data System to categorize patients who initiated ESRD care between 2003 and 2013 by age at ESRD onset (1-11, 12-21, and 22-29 years). Cardiovascular hospitalizations were identified via International Classification of Diseases, Ninth Revision discharge codes and CV mortality from the Centers for Medicare & Medicaid ESRD Death Notification Form. Patients were censored at death from non-CVD events, loss to follow-up, recovery, or survival to December 31, 2014. Adjusted proportional hazard models (95% CI) were fit to determine risk of CV hospitalization and mortality by age group. Data analysis occurred from May 2016 and December 2017. EXPOSURES Onset of ESRD. MAIN OUTCOMES AND MEASURES Cardiovascular mortality and hospitalization. RESULTS A total of 33 156 patients aged 1 to 29 years were included in the study population. Young adults (aged 22-29 years) had a 1-year CV hospitalization rate of 138 (95% CI, 121-159) per 1000 patient-years. Young adults had a higher risk for CV hospitalization than children (aged 1-11 years; hazard ratio [HR], 0.41 [95% CI, 0.26-0.64]) and adolescents (aged 12-21 years; HR, 0.86 [95% CI, 0.77-0.97]). Of 4038 deaths in young adults, 1577 (39.1%) were owing to CVD. Five-year cumulative incidence of mortality in this group (7.3%) was higher than in younger patients (adolescents, 4.0%; children, 1.7%). Adjusted HRs for CV mortality were higher for young adults with all causes of ESRD than children (

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Nephrology care prior to end-stage renal disease and outcomes among new ESRD patients in the USA

Cited by 83 publications

References 34 publications

Acute Kidney Injury before Dialysis Initiation Predicts Adverse Outcomes in Hemodialysis Patients

Acute Kidney Injury before Dialysis Initiation Predicts Adverse Outcomes in Hemodialysis Patients

Pre-End-Stage Renal Disease Care and Early Survival among Incident Dialysis Patients in the US Military Health System

Risk of Cardiovascular Disease and Mortality in Young Adults With End-stage Renal Disease

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