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Comparison of quality-of-care measures in U.S. patients with end-stage renal disease secondary to lupus nephritis vs. other causes.

Plantinga LC, Patzer RE, Drenkard C, Pastan SO, Cobb J, McClellan W, Lim SS - BMC Nephrol (2015)

Bottom Line: Multivariable logistic and Cox proportional hazards models were used to estimate adjusted odds ratios (ORs) and hazard ratios (HRs).However, only 24% had a permanent vascular access (fistula or graft) in place at dialysis start (vs. 36%; OR = 0.63, 95% CI 0.59-0.67).Further studies are warranted to examine barriers to permanent vascular access placement, as well as morbidity and mortality associated with temporary access, in patients with LN-ESRD.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Emory University, Atlanta, Georgia, USA. laura.plantinga@emory.edu.

ABSTRACT

Background: Patients with end-stage renal disease (ESRD) due to lupus nephritis (LN-ESRD) may be followed by multiple providers (nephrologists and rheumatologists) and have greater opportunities to receive recommended ESRD-related care. We aimed to examine whether LN-ESRD patients have better quality of ESRD care compared to other ESRD patients.

Methods: Among incident patients (7/05-9/11) with ESRD due to LN (n = 6,594) vs. other causes (n = 617,758), identified using a national surveillance cohort (United States Renal Data System), we determined the association between attributed cause of ESRD and quality-of-care measures (pre-ESRD nephrology care, placement on the deceased donor kidney transplant waitlist, and placement of permanent vascular access). Multivariable logistic and Cox proportional hazards models were used to estimate adjusted odds ratios (ORs) and hazard ratios (HRs).

Results: LN-ESRD patients were more likely than other ESRD patients to receive pre-ESRD care (71% vs. 66%; OR = 1.68, 95% CI 1.57-1.78) and be placed on the transplant waitlist in the first year (206 vs. 86 per 1000 patient-years; HR = 1.42, 95% CI 1.34-1.52). However, only 24% had a permanent vascular access (fistula or graft) in place at dialysis start (vs. 36%; OR = 0.63, 95% CI 0.59-0.67).

Conclusions: LN-ESRD patients are more likely to receive pre-ESRD care and have better access to transplant, but are less likely to have a permanent vascular access for dialysis, than other ESRD patients. Further studies are warranted to examine barriers to permanent vascular access placement, as well as morbidity and mortality associated with temporary access, in patients with LN-ESRD.

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Related in: MedlinePlus

Selection of analytic populations for examination of the association of attributed cause of ESRD with pre-ESRD nephrology care, access to transplant, and vascular access, among U.S. ESRD patients initiating treatment 7/05–9/11. Numbers by arrows represent the numbers of patients excluded by indicated criteria; numbers in boxes represent those remaining after prior exclusions.
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Fig1: Selection of analytic populations for examination of the association of attributed cause of ESRD with pre-ESRD nephrology care, access to transplant, and vascular access, among U.S. ESRD patients initiating treatment 7/05–9/11. Numbers by arrows represent the numbers of patients excluded by indicated criteria; numbers in boxes represent those remaining after prior exclusions.

Mentions: Data from the most recent (2005) version of the CMS-2728, completed on all treated U.S. incident ESRD patients, were obtained from the United States Renal Data System (USRDS) [15]. Patient consent was not required or possible in this secondary analysis of de-identified data, and the Emory Institutional Review Board approved the study protocol (IRB00063645). A total of 675,889 incident ESRD patients initiated treatment from 7/1/05 to 9/30/11 with available data on primary attributed cause of ESRD. Of these, 81,333 (12.0%) had unknown pre-ESRD nephrology care status and were excluded from these analyses (Figure 1). For analyses of measures of access to kidney transplantation (informed of transplant options and placement on the deceased donor kidney waitlist), those who received transplants without prior dialysis (n = 17,504), were placed on the waitlist prior to starting dialysis (n = 19,431), or were aged ≥70 years (n = 246,891) were excluded from the 675,889 ESRD patients, leaving 392,513 for analyses (Figure 1). For analyses of permanent vascular access, those who received transplants without prior dialysis (n = 17,504) or treated with peritoneal dialysis instead of hemodialysis (n = 42,360) were excluded, leaving 616,025 for analysis (Figure 1).Figure 1


Comparison of quality-of-care measures in U.S. patients with end-stage renal disease secondary to lupus nephritis vs. other causes.

Plantinga LC, Patzer RE, Drenkard C, Pastan SO, Cobb J, McClellan W, Lim SS - BMC Nephrol (2015)

Selection of analytic populations for examination of the association of attributed cause of ESRD with pre-ESRD nephrology care, access to transplant, and vascular access, among U.S. ESRD patients initiating treatment 7/05–9/11. Numbers by arrows represent the numbers of patients excluded by indicated criteria; numbers in boxes represent those remaining after prior exclusions.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4389993&req=5

Fig1: Selection of analytic populations for examination of the association of attributed cause of ESRD with pre-ESRD nephrology care, access to transplant, and vascular access, among U.S. ESRD patients initiating treatment 7/05–9/11. Numbers by arrows represent the numbers of patients excluded by indicated criteria; numbers in boxes represent those remaining after prior exclusions.
Mentions: Data from the most recent (2005) version of the CMS-2728, completed on all treated U.S. incident ESRD patients, were obtained from the United States Renal Data System (USRDS) [15]. Patient consent was not required or possible in this secondary analysis of de-identified data, and the Emory Institutional Review Board approved the study protocol (IRB00063645). A total of 675,889 incident ESRD patients initiated treatment from 7/1/05 to 9/30/11 with available data on primary attributed cause of ESRD. Of these, 81,333 (12.0%) had unknown pre-ESRD nephrology care status and were excluded from these analyses (Figure 1). For analyses of measures of access to kidney transplantation (informed of transplant options and placement on the deceased donor kidney waitlist), those who received transplants without prior dialysis (n = 17,504), were placed on the waitlist prior to starting dialysis (n = 19,431), or were aged ≥70 years (n = 246,891) were excluded from the 675,889 ESRD patients, leaving 392,513 for analyses (Figure 1). For analyses of permanent vascular access, those who received transplants without prior dialysis (n = 17,504) or treated with peritoneal dialysis instead of hemodialysis (n = 42,360) were excluded, leaving 616,025 for analysis (Figure 1).Figure 1

Bottom Line: Multivariable logistic and Cox proportional hazards models were used to estimate adjusted odds ratios (ORs) and hazard ratios (HRs).However, only 24% had a permanent vascular access (fistula or graft) in place at dialysis start (vs. 36%; OR = 0.63, 95% CI 0.59-0.67).Further studies are warranted to examine barriers to permanent vascular access placement, as well as morbidity and mortality associated with temporary access, in patients with LN-ESRD.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Emory University, Atlanta, Georgia, USA. laura.plantinga@emory.edu.

ABSTRACT

Background: Patients with end-stage renal disease (ESRD) due to lupus nephritis (LN-ESRD) may be followed by multiple providers (nephrologists and rheumatologists) and have greater opportunities to receive recommended ESRD-related care. We aimed to examine whether LN-ESRD patients have better quality of ESRD care compared to other ESRD patients.

Methods: Among incident patients (7/05-9/11) with ESRD due to LN (n = 6,594) vs. other causes (n = 617,758), identified using a national surveillance cohort (United States Renal Data System), we determined the association between attributed cause of ESRD and quality-of-care measures (pre-ESRD nephrology care, placement on the deceased donor kidney transplant waitlist, and placement of permanent vascular access). Multivariable logistic and Cox proportional hazards models were used to estimate adjusted odds ratios (ORs) and hazard ratios (HRs).

Results: LN-ESRD patients were more likely than other ESRD patients to receive pre-ESRD care (71% vs. 66%; OR = 1.68, 95% CI 1.57-1.78) and be placed on the transplant waitlist in the first year (206 vs. 86 per 1000 patient-years; HR = 1.42, 95% CI 1.34-1.52). However, only 24% had a permanent vascular access (fistula or graft) in place at dialysis start (vs. 36%; OR = 0.63, 95% CI 0.59-0.67).

Conclusions: LN-ESRD patients are more likely to receive pre-ESRD care and have better access to transplant, but are less likely to have a permanent vascular access for dialysis, than other ESRD patients. Further studies are warranted to examine barriers to permanent vascular access placement, as well as morbidity and mortality associated with temporary access, in patients with LN-ESRD.

Show MeSH
Related in: MedlinePlus