| Treatment center and geographic variability in pre-ESRD care associate with increased mortality. | |
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MedLine Citation:
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PMID: 19321704 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Late referral of patients with chronic kidney disease is associated with increased morbidity and mortality, but the contribution of center-to-center and geographic variability of pre-ESRD nephrology care to mortality of patients with ESRD is unknown. We evaluated the pre-ESRD care of > 30,000 incident hemodialysis patients, 5088 (17.8%) of whom died during follow-up (median 365 d). Approximately half (51.3%) of incident patients had received at least 6 mo of pre-ESRD nephrology care, as reported by attending physicians. Pre-ESRD nephrology care was independently associated with survival (odds ratio 1.54; 95% confidence interval 1.45 to 1.64). There was substantial center-to-center variability in pre-ESRD care, which was associated with increased facility-specific death rates. As the proportion of patients who were in a treatment center and receiving pre-ESRD nephrology care increased from lowest to highest quintile, the mortality rate decreased from 19.6 to 16.1% (P = 0.0031). In addition, treatment centers in the lowest quintile of pre-ESRD care were clustered geographically. In conclusion, pre-ESRD nephrology care is highly variable among treatment centers and geographic regions. Targeting these disparities could have substantial clinical impact, because the absence of > or = 6 mo of pre-ESRD care by a nephrologist is associated with a higher risk for death. |
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Authors:
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William M McClellan; Haimanot Wasse; Ann C McClellan; Adam Kipp; Lance A Waller; Michael V Rocco |
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Publication Detail:
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Type: Journal Article; Research Support, N.I.H., Extramural Date: 2009-03-25 |
Journal Detail:
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Title: Journal of the American Society of Nephrology : JASN Volume: 20 ISSN: 1533-3450 ISO Abbreviation: J. Am. Soc. Nephrol. Publication Date: 2009 May |
Date Detail:
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Created Date: 2009-05-01 Completed Date: 2009-05-20 Revised Date: 2010-09-22 |
Medline Journal Info:
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Nlm Unique ID: 9013836 Medline TA: J Am Soc Nephrol Country: United States |
Other Details:
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Languages: eng Pagination: 1078-85 Citation Subset: IM |
Affiliation:
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Emory University School of Medicine, Renal Division, Rollins School of Public Health, Room 476, 1518 Clifton Road, Atlanta, GA 30322, USA. wmcclel@sph.emory.edu |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Anemia
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epidemiology Geography Health Status Humans Kidney Failure, Chronic / complications, epidemiology, mortality*, therapy* Nephrology / standards* Quality Assurance, Health Care Quality of Life Referral and Consultation Renal Dialysis / statistics & numerical data Risk Factors Serum Albumin / metabolism Survival Rate United States |
| Grant Support | |
ID/Acronym/Agency:
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K23 DK65634/DK/NIDDK NIH HHS |
| Chemical | |
Reg. No./Substance:
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0/Serum Albumin |
| Comments/Corrections | |
Comment In:
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J Am Soc Nephrol. 2009 May;20(5):930-2
[PMID:
19389840
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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