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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

Cumulative incidence of placement on the deceased donor kidney transplant waitlist among U.S. ESRD patients initiating treatment 7/05–9/11, by attributed cause of ESRD.P < 0.001 by log-rank.
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Fig2: Cumulative incidence of placement on the deceased donor kidney transplant waitlist among U.S. ESRD patients initiating treatment 7/05–9/11, by attributed cause of ESRD.P < 0.001 by log-rank.

Mentions: Incidence of placement on the kidney transplant waitlist was 97 per 1000 patient-years overall but was more than twice as high among LN-ESRD and GN-ESRD patients as compared to other ESRD patients (Table 2). Placement on the waitlist increased over time among patients with all causes of ESRD, although the trend was marginally statistically significant for LN-ESRD patients (Table 2). Time to placement was similar among ESRD patients with LN and GN but was much shorter among both groups of patients compared to other ESRD patients (Figure 2). Adjusted analyses showed that the rate of placement on the waitlist among LN-ESRD patients was 42% higher than that among other ESRD patients in the first year of ESRD; this relatively increased rate was even higher (56%) after the first year (Table 3). In comparison, GN-ESRD patients had nearly twice the rate of placement on the kidney transplant waitlist as other ESRD patients in the first year but only a ~40% higher rate after the first year (Table 3). When those aged ≥70 years were included, results were nearly identical [within first year: LN-ESRD, OR = 1.42 (95% CI, 1.34–1.52); GN-ESRD, OR = 1.91 (95% CI, 1.86–1.96); after first year: [LN-ESRD, OR = 1.56 (95% CI, 1.45–1.67); GN-ESRD, OR = 1.39 (95% CI, 1.35–1.44)]. Results in other sensitivity analyses were also similar (Table 4). When being transplanted without placement on the waitlist (which occurred in 1.6%, 1.2%, and 1.0% of patients with ESRD due to LN, GN, and all other causes, respectively) was combined with placement on the waitlist as an outcome, associations were only slightly attenuated (data not shown).Figure 2


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)

Cumulative incidence of placement on the deceased donor kidney transplant waitlist among U.S. ESRD patients initiating treatment 7/05–9/11, by attributed cause of ESRD.P < 0.001 by log-rank.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Fig2: Cumulative incidence of placement on the deceased donor kidney transplant waitlist among U.S. ESRD patients initiating treatment 7/05–9/11, by attributed cause of ESRD.P < 0.001 by log-rank.
Mentions: Incidence of placement on the kidney transplant waitlist was 97 per 1000 patient-years overall but was more than twice as high among LN-ESRD and GN-ESRD patients as compared to other ESRD patients (Table 2). Placement on the waitlist increased over time among patients with all causes of ESRD, although the trend was marginally statistically significant for LN-ESRD patients (Table 2). Time to placement was similar among ESRD patients with LN and GN but was much shorter among both groups of patients compared to other ESRD patients (Figure 2). Adjusted analyses showed that the rate of placement on the waitlist among LN-ESRD patients was 42% higher than that among other ESRD patients in the first year of ESRD; this relatively increased rate was even higher (56%) after the first year (Table 3). In comparison, GN-ESRD patients had nearly twice the rate of placement on the kidney transplant waitlist as other ESRD patients in the first year but only a ~40% higher rate after the first year (Table 3). When those aged ≥70 years were included, results were nearly identical [within first year: LN-ESRD, OR = 1.42 (95% CI, 1.34–1.52); GN-ESRD, OR = 1.91 (95% CI, 1.86–1.96); after first year: [LN-ESRD, OR = 1.56 (95% CI, 1.45–1.67); GN-ESRD, OR = 1.39 (95% CI, 1.35–1.44)]. Results in other sensitivity analyses were also similar (Table 4). When being transplanted without placement on the waitlist (which occurred in 1.6%, 1.2%, and 1.0% of patients with ESRD due to LN, GN, and all other causes, respectively) was combined with placement on the waitlist as an outcome, associations were only slightly attenuated (data not shown).Figure 2

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