Does predialysis nephrology care influence patient survival after initiation of dialysis?

Khan, Samina; Xue, Jay L.; Kazmi, Waqar; Gilbertson, David T.; Obrador, Gregorio T.; Pereira, Brian J.G.; Collins, Allan J.

doi:10.1111/j.1523-1755.2005.00168.x

Cited by 109 publications

(98 citation statements)

References 49 publications

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“…9,11 Secara umum didapatkan bahwa sekitar satu dari delapan pasien yang memulai HD meninggal dalam 3 bulan pertama setelah HD. 10,13 Kematian pada tahun pertama hemodialisis paling banyak disebabkan oleh penyakit jantung. Bradburry menyebutkan bahwa sesuai dengan proporsi kematian yang paling tinggi pada 120 hari pertama setelah dialisis, kematian akibat penyakit jantung juga didapatkan secara signifikan lebih tinggi pada 120 hari pertama.…”

Section: Pendahuluanunclassified

“…Penelitian prospektif oleh Khan pada tahun 2005 mendapatkan bahwa usia dan kunjungan ke konsultan nefrologi dalam 6 bulan terakhir merupakan prediktor mortalitas yang bermakna. 13 Metcalfe pada tahun 2000 menemukan bahwa HD yang dimulai tanpa perencanaan (emergensi) memiliki angka mortalitas 6 sampai 8,9 kali lebih tinggi dibandingkan HD yang dimulai secara terencana. Penelitian ini juga mendapatkan bahwa pasien dengan komorbiditas yang lebih tinggi juga memiliki angka kematian yang lebih tinggi.…”

Section: Pendahuluanunclassified

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Pengembangan Model Prediksi Mortalitas 3 Bulan Pertama pada Pasien Penyakit Ginjal Kronik yang Menjalani Hemodialisis

Umami¹,

Lydia²,

Nainggolan³

et al. 2017

JPDI

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ABSTRAKPendahuluan. Mortalitas pasien yang menjalani hemodialisis (HD) paling tinggi pada tiga bulan pertama. Data mengenai insidens dan prediktor mortalitas dini pada pasien HD sangat terbatas. Suatu model prediksi dapat menjadi alat bantu yang sederhana untuk mengetahui pasien yang berisiko tinggi sehingga pada akhirnya upaya pencegahan dapat dilakukan. Penelitian ini bertujuan untuk mengetahui insidens dan prediktor mortalitas 3 bulan pada pasien hemodialisis baru dan membuat suatu model prediksi.Metode. Penelitian dengan disain kohort retrospektif terhadap 246 pasien PGTA yang baru menjalani HD di Unit HD RSCM antara Januari 2011-Januari 2012. Dilakukan analisis chi-square untuk mendapatkan nilai OR (Odds Ratio) terhadap variabel usia, pembiayaan, jenis HD, akses pembuluh darah, anemia, hipoalbuminemia, kelainan EKG, kardiomegali, komorbid, waktu rujukan ke nefrologis, dan kepatuhan. Prediktor yang bermakna kemudian dimasukkan pada model regresi logistik untuk mendapatkan sistem skor.Hasil. Sebanyak 78 (31,7%) dari 246 pasien meninggal dalam 3 bulan pertama. Terdapat 5 variabel yang berhubungan dengan terjadinya mortalitas 3 bulan yaitu usia > 60 tahun, hemoglobin <8 g/dl, albumin serum <3,5 g/dl, kelainan EKG, dan akses femoral. Skor prediksi untuk prediktor usia, hemoglobin, albumin serum, kelainan EKG, dan akses pembuluh darah berturut-turut sebesar 1, 3, 1, 3, 1. Jumlah skor kemudian dikategorikan menjadi risiko rendah (skor 0-3), sedang (skor 4-6), dan tinggi (skor 7-9). Tiap kelompok memiliki prediksi mortalitas 3 bulan berturut-turut sebesar 1,23%, 26,69%, dan 86,04%.Simpulan. Insidens mortalitas 3 bulan pada pasien HD baru sebesar 31,7%. Usia > 60 tahun, hemoglobin <8 g/dl, albumin serum <3,5 g/dl, kelainan EKG, dan akses femoral merupakan prediktor yang bermakna terhadap terjadinya mortalitas dalam 3 bulan pertama HD. Kata kunci. Hemodialisis, insidens, mortalitas 3 bulan, sistem skor.

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Section: Pendahuluanunclassified

Pengembangan Model Prediksi Mortalitas 3 Bulan Pertama pada Pasien Penyakit Ginjal Kronik yang Menjalani Hemodialisis

Umami¹,

Lydia²,

Nainggolan³

et al. 2017

JPDI

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“…Although the appropriate timing of nephrology referral is unclear (29), late referral has been associated with a vast array of poor outcomes (3,(30)(31)(32)(33). Furthermore, early nephrology referral has been shown to slow the progression of CKD (34,35).…”

Section: Discussionmentioning

confidence: 99%

Documentation and Management of CKD in Rural Primary Care

Rao

Morris

O’Malley³

et al. 2013

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Recognition of CKD by primary care practitioners is essential in rural communities where nephrology access is limited. This study determined the prevalence of undocumented CKD in patients cared for in rural primary care practices and evaluated characteristics associated with undocumented CKD as well as CKD management.Design, setting, participants, & measurements A retrospective cohort study, conducted within the Oregon Rural Practice Based Research Network, consisted of 865 CKD patients with serum creatinine$1.5 mg/dl in males and $1.3 mg/dl in females and an estimated GFR,60 ml/min per 1.73 m 2 . Documentation of a CKD diagnosis and laboratory values were abstracted by chart review.Results Of CKD patients, 51.9% had no documentation of CKD. Undocumented CKD occurred more frequently in female patients (adjusted odds ratio=2.93, 95% confidence interval=2.04, 4.21). The association of serum creatinine reporting versus automating reporting of estimated GFR on CKD documentation was dependent on patient sex, years of practitioner experience, and practitioner clinical training. Hypertensive patients with documented CKD were more likely to have a BP medication change than patients with undocumented CKD (odds ratio=2.07, 95% confidence interval=1.15, 3.73). Only 2 of 449 patients with undocumented CKD were comanaged with a nephrologist compared with 20% of patients with documented CKD (odds ratio=53.20, 95% confidence interval=14.90, 189.90).Conclusions Undocumented CKD in a rural primary care setting is frequent, particularly in female patients. Depending on practitioner characteristics, automatic reporting of estimated GFR might improve documentation of CKD in this population.

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“…1,2 Absent or late predialysis nephrology care is associated with poorer blood pressure (BP) control, worse biochemical parameters, and lower receipt of permanent vascular access among patients at dialysis initiation. 3,4 Furthermore, patients with CKD who are referred late to nephrologists (less than 3-4 months before initiation of dialysis) have been shown to have higher mortality in the first 3,[5][6][7] or second 8,9 year after initiation of dialysis.…”

Section: Introductionmentioning

confidence: 99%

Influence of Nephrologist Care on Management and Outcomes in Adults with Chronic Kidney Disease

et al. 2015

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BACKGROUND: Predialysis nephrology care for adults with late stage chronic kidney disease (CKD) is associated with improved outcomes. Less is known about the effects of nephrology care in earlier stages of CKD. OBJECTIVE: We aimed to evaluate the effect of nephrology care on management of CKD risk factors and complications, CKD progression, incident cardiovascular disease (CVD), and death. DESIGN: This was a prospective cohort study. PARTICIPANTS: Participants included 3855 men and women aged 21 to 74 years enrolled in the Chronic Renal Insufficiency Cohort (CRIC) Study with a mean (SD) estimated glomerular filtration rate (eGFR) at entry of 45 (17) ml/min/1.73 m 2 , followed for a median of 6.6 years. MAIN MEASURES: The main predictor was self-reported prior contact with a nephrologist at study enrollment. Outcomes evaluated included CKD progression (≥ 50 % eGFR loss or end-stage renal disease), incident CVD, and death. RESULTS: Two-thirds (67 %) of the participants reported prior contact with a nephrologist at study enrollment. They were younger, more likely to be male, non-Hispanic white, and had lower eGFR and higher urine protein (p < 0.05). A subgroup with eGFR 30-< 60 ml/min/1.73 m 2 and prior contact with a nephrologist were more likely to receive pharmacologic treatment for CKD-related complications and to report angiotensin-converting enzyme inhibitor or angiotensin receptor blocker (ACEi/ARB) use. After propensity score matching (for reporting prior contact with a nephrologist vs. not) and adjusting for demographic and clinical variables, prior contact with a nephrologist was not significantly associated with CKD progression, incident CVD or death (p > 0.05). CONCLUSIONS: One-third of CRIC participants had not seen a nephrologist before enrollment, and this prior contact was subject to age, sex, and ethnic-related disparities. While prior nephrology care was associated with more frequent treatment of CKD complications and use of ACEi/ARB medications, there was neither an association between this care and achievement of guidelinerecommended intermediate measures, nor long-term adverse outcomes.

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Does predialysis nephrology care influence patient survival after initiation of dialysis?

Cited by 109 publications

References 49 publications

Pengembangan Model Prediksi Mortalitas 3 Bulan Pertama pada Pasien Penyakit Ginjal Kronik yang Menjalani Hemodialisis

Pengembangan Model Prediksi Mortalitas 3 Bulan Pertama pada Pasien Penyakit Ginjal Kronik yang Menjalani Hemodialisis

Documentation and Management of CKD in Rural Primary Care

Influence of Nephrologist Care on Management and Outcomes in Adults with Chronic Kidney Disease

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