Document Detail


Association of physician care with mortality in Kidney Early Evaluation Program (KEEP) participants.
MedLine Citation:
PMID:  22339900     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: People with or at high risk of chronic kidney disease (CKD) are at increased risk of premature morbidity and mortality. We sought to examine the effect of care provided by a primary care physician (PCP) on survival for all participants in the National Kidney Foundation's Kidney Early Evaluation Program (KEEP) and the effect of care provided by a nephrologist on survival for KEEP participants with estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m(2).
METHODS: Provision of care by a PCP (n = 138,331) or nephrologist (n = 10,797) was defined using self-report of seeing that provider within the past year. Survival was ascertained by linking KEEP data to the Social Security Administration Death Master File. Multivariable Cox proportional hazards models examining the relationship between primary care and nephrologist provider status adjusted for age, sex, race, smoking status, education, health insurance, diabetes, cardiovascular disease, hypertension, cancer, albuminuria, body mass index, baseline eGFR, and hemoglobin level, with nephrology models further adjusting for calcium, phosphorus, and parathyroid hormone levels.
RESULTS: Of all participants, 70.9% (98,050 of 138,331) reported receiving PCP care; older age and female sex were associated with this care. During a median follow-up of 4.2 years, 4,836 deaths occurred. After multivariable adjustment, receiving PCP care and mortality were not associated (HR, 0.94; 95% CI, 0.86-1.03; P = 0.2). Of participants with eGFR <60 mL/min/1.73 m(2), 10.1% (1,095 of 10,797) reported receiving nephrology care; younger age and male sex were associated with receipt of nephrology care. During a mean follow-up of 2.2 years, 558 deaths occurred. After multivariable adjustment, nephrologist care was not associated with mortality (HR, 1.01; 95% CI, 0.75-1.36; P = 0.9). These associations were not modified by other specialist care (endocrinologist or cardiologist).
CONCLUSIONS: For all KEEP participants, neither PCP nor nephrology care was associated with improved survival. These results highlight the need to explore the connection between access to health care and outcomes in persons at high risk of or with CKD.
Authors:
Georges Saab; Shu-Cheng Chen; Suying Li; Andrew S Bomback; Adam T Whaley-Connell; Claudine T Jurkovitz; Keith C Norris; Peter A McCullough;
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, Non-P.H.S.; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  American journal of kidney diseases : the official journal of the National Kidney Foundation     Volume:  59     ISSN:  1523-6838     ISO Abbreviation:  Am. J. Kidney Dis.     Publication Date:  2012 Mar 
Date Detail:
Created Date:  2012-02-20     Completed Date:  2012-04-23     Revised Date:  2013-06-26    
Medline Journal Info:
Nlm Unique ID:  8110075     Medline TA:  Am J Kidney Dis     Country:  United States    
Other Details:
Languages:  eng     Pagination:  S34-9     Citation Subset:  IM    
Copyright Information:
Copyright © 2012 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.
Affiliation:
Renal Division, Washington University School of Medicine, St Louis, MO 63110, USA. gsaab@dom.wustl.edu
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MeSH Terms
Descriptor/Qualifier:
Aged
Female
Health Promotion*
Humans
Kidney Diseases / mortality*,  prevention & control*
Male
Middle Aged
Nephrology*
Primary Health Care*
Survival Rate
United States
Grant Support
ID/Acronym/Agency:
MD000182/MD/NIMHD NIH HHS; P20 MD000182/MD/NIMHD NIH HHS; P30 AG021684/AG/NIA NIH HHS; R03 AG040638/AG/NIA NIH HHS; R03AG040638-01/AG/NIA NIH HHS; RR026138/RR/NCRR NIH HHS; U54 MD007598/MD/NIMHD NIH HHS; U54 RR026138/RR/NCRR NIH HHS; UL1 TR000124/TR/NCATS NIH HHS
Investigator
Investigator/Affiliation:
Peter A McCullough / ; Adam T Whaley-Connell / ; Andrew Bomback / ; Kerri Cavanaugh / ; Linda Fried / ; Claudine Jurkovitz / ; Mikhail Kosiborod / ; Samy McFarlane / ; Rajnish Mehrotr / ; Keith Norris / ; Rulan Savita Parekh / ; Carmen A Peralta / ; Georges Saab / ; Stephen Seliger / ; Michael Shlipak / ; Lesley Inker / ; Manjula Kurella Tamura / ; John Wang / ; Bryan Becker / ; Allan Collins / ; Nilka Ríos Burrows / ; Lynda A Szczech / ; Joseph Vasssalott / ; George Bakris / ; Wendy Brown / ; Shu-Cheng Chen /
Comments/Corrections

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