Early referral to specialist nephrology services for preventing the progression to end-stage kidney disease

Association between Duration of Predialysis Care and Mortality after Dialysis Start

“…Using an analytic approach that reflects this view, our data show that people with longer predialysis care had 40% lower mortality after dialysis start than people with shorter or no predialysis care. Our estimates of risk reduction mirror a recent metaanalysis of 40 cohort studies involving over 60,000 participants (6). However, when we allowed for the possibilities that the risk of acute events may be affected by predialysis care and that acute events may influence the course of disease and therefore, may affect both duration of predialysis care and mortality (19), we found that the benefit associated with longer predialysis care was weaker and no longer significant.…”

Association between Duration of Predialysis Care and Mortality after Dialysis Start

“…Using an analytic approach that reflects this view, our data show that people with longer predialysis care had 40% lower mortality after dialysis start than people with shorter or no predialysis care. Our estimates of risk reduction mirror a recent metaanalysis of 40 cohort studies involving over 60,000 participants (6). However, when we allowed for the possibilities that the risk of acute events may be affected by predialysis care and that acute events may influence the course of disease and therefore, may affect both duration of predialysis care and mortality (19), we found that the benefit associated with longer predialysis care was weaker and no longer significant.…”

Disparities in Chronic Kidney Disease Progression by Medicare Advantage Enrollees

“…It is possible that CKD is only diagnosed once patients’ CKD has progressed sufficiently to warrant closer monitoring and clinical recognition. Such clinical recognition is highly correlated with receipt of nephrology consultation and supports prior work indicating that early referral and intervention by nephrology can slow CKD progression and improve dialysis preparedness [30]. This finding also signals an opportunity to improve recognition and documentation of CKD for nonnephrology providers and improve timely referral to nephrology care.…”

Sex Differences in the Recognition, Monitoring, and Management of CKD in Health Care: An Observational Cohort Study

“…Among those who satisfied guideline-recommended criteria for nephrologist referral, fewer women than men visited a nephrologist, even among those who had CKD confirmed with repeated testing. Late referral to nephrology units has been associated with faster disease progression and worse outcomes, 47 and in our data sex-related differences in referral patterns, although somewhat attenuated with increasing severity, were large. It has been argued that nephrology units lack the capacity to accommodate so many patients with CKD, and that management is best decentralized, with larger responsibility for primary health care settings.…”

Association between Duration of Predialysis Care and Mortality after Dialysis Start

“…Using an analytic approach that reflects this view, our data show that people with longer predialysis care had 40% lower mortality after dialysis start than people with shorter or no predialysis care. Our estimates of risk reduction mirror a recent metaanalysis of 40 cohort studies involving over 60,000 participants (6). However, when we allowed for the possibilities that the risk of acute events may be affected by predialysis care and that acute events may influence the course of disease and therefore, may affect both duration of predialysis care and mortality (19), we found that the benefit associated with longer predialysis care was weaker and no longer significant.…”

Disparities in Chronic Kidney Disease Progression by Medicare Advantage Enrollees

“…It is possible that CKD is only diagnosed once patients’ CKD has progressed sufficiently to warrant closer monitoring and clinical recognition. Such clinical recognition is highly correlated with receipt of nephrology consultation and supports prior work indicating that early referral and intervention by nephrology can slow CKD progression and improve dialysis preparedness [30]. This finding also signals an opportunity to improve recognition and documentation of CKD for nonnephrology providers and improve timely referral to nephrology care.…”

Sex Differences in the Recognition, Monitoring, and Management of CKD in Health Care: An Observational Cohort Study

“…Among those who satisfied guideline-recommended criteria for nephrologist referral, fewer women than men visited a nephrologist, even among those who had CKD confirmed with repeated testing. Late referral to nephrology units has been associated with faster disease progression and worse outcomes, 47 and in our data sex-related differences in referral patterns, although somewhat attenuated with increasing severity, were large. It has been argued that nephrology units lack the capacity to accommodate so many patients with CKD, and that management is best decentralized, with larger responsibility for primary health care settings.…”

Association between Duration of Predialysis Care and Mortality after Dialysis Start

“…Using an analytic approach that reflects this view, our data show that people with longer predialysis care had 40% lower mortality after dialysis start than people with shorter or no predialysis care. Our estimates of risk reduction mirror a recent metaanalysis of 40 cohort studies involving over 60,000 participants (6). However, when we allowed for the possibilities that the risk of acute events may be affected by predialysis care and that acute events may influence the course of disease and therefore, may affect both duration of predialysis care and mortality (19), we found that the benefit associated with longer predialysis care was weaker and no longer significant.…”

Disparities in Chronic Kidney Disease Progression by Medicare Advantage Enrollees

“…It is possible that CKD is only diagnosed once patients’ CKD has progressed sufficiently to warrant closer monitoring and clinical recognition. Such clinical recognition is highly correlated with receipt of nephrology consultation and supports prior work indicating that early referral and intervention by nephrology can slow CKD progression and improve dialysis preparedness [30]. This finding also signals an opportunity to improve recognition and documentation of CKD for nonnephrology providers and improve timely referral to nephrology care.…”

Sex Differences in the Recognition, Monitoring, and Management of CKD in Health Care: An Observational Cohort Study

“…Among those who satisfied guideline-recommended criteria for nephrologist referral, fewer women than men visited a nephrologist, even among those who had CKD confirmed with repeated testing. Late referral to nephrology units has been associated with faster disease progression and worse outcomes, 47 and in our data sex-related differences in referral patterns, although somewhat attenuated with increasing severity, were large. It has been argued that nephrology units lack the capacity to accommodate so many patients with CKD, and that management is best decentralized, with larger responsibility for primary health care settings.…”