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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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Permanent vascular access placement by patient characteristics, among U.S. ESRD patients initiating treatment 7/05–9/11, by attributed cause of ESRD. Recovery of renal function is defined as recovery occurring at any time during treatment, regardless of whether patient returned to dialysis; early transplant is defined as a transplant within 1 year of ESRD start.
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Fig3: Permanent vascular access placement by patient characteristics, among U.S. ESRD patients initiating treatment 7/05–9/11, by attributed cause of ESRD. Recovery of renal function is defined as recovery occurring at any time during treatment, regardless of whether patient returned to dialysis; early transplant is defined as a transplant within 1 year of ESRD start.

Mentions: More than one-third of all dialysis patients had a permanent vascular access in place at the start of treatment, but fewer than one-quarter of LN-ESRD patients had a fistula or graft in place (Table 2). There were no differences over time in permanent vascular access placement overall or by cause of ESRD (Table 2). With adjustment, LN-ESRD patients remained nearly 40% less likely than other ESRD patients to have a permanent vascular access used or in place at first dialysis, whereas GN-ESRD patients were 10% more likely than other ESRD patients to have a permanent vascular access (Table 3). Results were similar in sensitivity analyses (Table 4). Placement of permanent access was far less common among patients who recovered function at any point, compared to those who did not recover function, regardless of attributed cause (Figure 3). Patients with other causes of ESRD who had early transplants (within 1 year of ESRD start) were more likely than similar patients who had not received a transplant within 1 year of ESRD start to have a permanent vascular access (P < 0.001), but this was not true among LN-ESRD or GN-ESRD patients (Figure 3). Among those with early transplants and with full adjustment, both LN-ESRD (OR = 0.66, 95% CI, 0.48–0.92) and GN-ESRD (OR = 0.83, 95% CI, 0.74–0.93) patients were less likely than other ESRD patients to have a permanent vascular access in place at start of ESRD. For all attributed cause groups, males were more likely than females to have a permanent vascular access used or in place at the start of ESRD (P < 0.05 for all causes; Figure 3).Figure 3


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)

Permanent vascular access placement by patient characteristics, among U.S. ESRD patients initiating treatment 7/05–9/11, by attributed cause of ESRD. Recovery of renal function is defined as recovery occurring at any time during treatment, regardless of whether patient returned to dialysis; early transplant is defined as a transplant within 1 year of ESRD start.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Fig3: Permanent vascular access placement by patient characteristics, among U.S. ESRD patients initiating treatment 7/05–9/11, by attributed cause of ESRD. Recovery of renal function is defined as recovery occurring at any time during treatment, regardless of whether patient returned to dialysis; early transplant is defined as a transplant within 1 year of ESRD start.
Mentions: More than one-third of all dialysis patients had a permanent vascular access in place at the start of treatment, but fewer than one-quarter of LN-ESRD patients had a fistula or graft in place (Table 2). There were no differences over time in permanent vascular access placement overall or by cause of ESRD (Table 2). With adjustment, LN-ESRD patients remained nearly 40% less likely than other ESRD patients to have a permanent vascular access used or in place at first dialysis, whereas GN-ESRD patients were 10% more likely than other ESRD patients to have a permanent vascular access (Table 3). Results were similar in sensitivity analyses (Table 4). Placement of permanent access was far less common among patients who recovered function at any point, compared to those who did not recover function, regardless of attributed cause (Figure 3). Patients with other causes of ESRD who had early transplants (within 1 year of ESRD start) were more likely than similar patients who had not received a transplant within 1 year of ESRD start to have a permanent vascular access (P < 0.001), but this was not true among LN-ESRD or GN-ESRD patients (Figure 3). Among those with early transplants and with full adjustment, both LN-ESRD (OR = 0.66, 95% CI, 0.48–0.92) and GN-ESRD (OR = 0.83, 95% CI, 0.74–0.93) patients were less likely than other ESRD patients to have a permanent vascular access in place at start of ESRD. For all attributed cause groups, males were more likely than females to have a permanent vascular access used or in place at the start of ESRD (P < 0.05 for all causes; Figure 3).Figure 3

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