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Provider and Care Characteristics Associated with Timing of Dialysis Initiation.
MedLine Citation:
PMID:  24436477     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: and objectives There is a trend in the United States to maintenance dialysis initiation at higher levels of estimated GFR. This study aimed to determine whether provider characteristics and pre-ESRD nephrology care and vascular access are independently associated with higher estimated GFR at initiation.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This retrospective cohort study used US Renal Data System data for patients who initiated dialysis in 2006 (n=83,621) and American Medical Association Physician Master File data for provider characteristics. Patient characteristics and estimated GFR were defined, and providers at dialysis initiation were identified. Earlier dialysis initiation was defined as initiation at estimated GFR>10 ml/min per 1.73 m(2). Nephrologist density per 100 ESRD patients was calculated by Health Service Area in 2006. Associations between provider characteristics and estimated GFR were determined using logistic regression and linear regression models, accounting for provider clustering.
RESULTS: Of the cohort, 47.8% of patients initiated dialysis at estimated GFR>10 ml/min per 1.73 m(2), and 16.2% of patients initiated dialysis at estimated GFR≥15 ml/min per 1.73 m(2). Predialysis nephrologist care for 0-12 months was associated with greater odds of earlier initiation compared with no care. Patients initiating with an arteriovenous fistula or graft were more likely to initiate earlier than patients initiating with a catheter. Provider sex was not associated with timing of dialysis initiation as measured by estimated GFR. Care by providers who graduated from nondomestic medical schools was associated with greater odds of earlier initiation. Greater provider experience was associated with lower likelihood of earlier initiation.
CONCLUSION: This study supports the hypothesis that provider factors are associated with timing of dialysis initiation in the United States.
Authors:
Yelena Slinin; Haifeng Guo; Suying Li; Jiannong Liu; Benjamin Morgan; Kristine Ensrud; David T Gilbertson; Allan J Collins; Areef Ishani
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-1-16
Journal Detail:
Title:  Clinical journal of the American Society of Nephrology : CJASN     Volume:  -     ISSN:  1555-905X     ISO Abbreviation:  Clin J Am Soc Nephrol     Publication Date:  2014 Jan 
Date Detail:
Created Date:  2014-1-17     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101271570     Medline TA:  Clin J Am Soc Nephrol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
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