Improving Outcomes in Patients Receiving Dialysis: The Peer Kidney Care Initiative

Wetmore, James B.; Gilbertson, David T.; Liu, Jiannong; Collins, Allan J.

doi:10.2215/cjn.12981215

Cited by 20 publications

(19 citation statements)

References 32 publications

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“…It is plausible that a concerted effort to improve standards of dialysis care has resulted in a reduced mortality risk, as observed in this large nationwide sample. The Peer Kidney Initiative created in 2014 by the chief medical officers of 14 United States dialysis provider organizations and the Chronic Disease Research Group reported regional variations in the rates of ESRD incidence, hospitalization, and pre-ESRD care, and suggested the possible role of environmental conditions on outcomes in patients receiving maintenance dialysis [38]. Geographic factors that likely affect care, such as socioeconomic fac- tors, environmental factors (e.g., pollution), local factors (e.g., barriers to care), and idiosyncrasies of care delivery systems, are poorly captured in the administrative databases, and future studies are needed to investigate these areas.…”

Section: Discussionmentioning

confidence: 99%

Temporal Trends in Incident Mortality in Dialysis Patients: Focus on Sex and Racial Disparities

et al. 2019

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Background: Racial minorities and women constitute substantial portions of the incident and prevalent end-stage renal disease (ESRD) population in the United States. Although ESRD is characterized by high mortality, temporal trends, and race and sex differences in mortality have not been studied. Methods: We evaluated 944,650 adult patients who initiated dialysis between January 1, 2005 and December 31, 2014, using the United States Renal Data System, for sex-related and race-related trends in mortality. Logistic regression models adjusted for pre-dialysis health status were used to examine associations among the predictors’ sex, race, and year of incident dialysis, and the outcome all-cause mortality at 1-year post ESRD. Results: The mean age was 65 ± 14 years. The 1-year crude mortality rates in incident ESRD patients decreased by 28% from 2004 to 2015. Risk-adjusted 1-year mortality decreased by 3% for each later year of incident ESRD (p < 0.001). In general, from 2005 to 2014, mortality rates decreased across both sexes, and all races. White patients experienced the lowest reduction in adjusted 1-year mortality rates (16%). While women experienced a survival advantage over men in 2005, by 2014 it was reversed to survival advantage for men. Combining all years, the adjusted risk of dying at 1-year after initiating dialysis was lower in women than men (OR 0.98; 95% CI 0.97–0.99), and as compared to whites, was lower in blacks (OR 0.73; 95% CI 0.72–0.74), Hispanics (OR 0.64; 95% CI 0.63–0.65), Asians (OR 0.55; 95% CI 0.53–0.56), and Native Americans (OR 0.67; 95% CI 0.63–0.71). Conclusion: The 1-year mortality rates among patients with ESRD have decreased steadily during a recent 10-year period across both men and women, and in all 5 races. Women have only a 2% lower risk of dying at 1-year after dialysis initiation than men. White patients had higher mortality as compared to other races. Our results suggest the need for sex, and race-specific treatment strategies in ESRD care.

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Section: Discussionmentioning

confidence: 99%

Temporal Trends in Incident Mortality in Dialysis Patients: Focus on Sex and Racial Disparities

et al. 2019

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“…For example, we found a twofold difference between regions in predialysis access to a nephrologist and AVF placement and a more than fourfold difference in incident mortality. Variation in care may be related to historical, social, cultural, economic, demographic, or other features, such as climate or geologic features; controlling for such factors may be difficult analytically, and some comparisons may not be analytically sound (5). It may even be unrealistic to expect outcomes to improve equally across regions, even if the aspiration is laudable.…”

Section: Discussionmentioning

confidence: 99%

The Healthy People 2020 Objectives for Kidney Disease: How Far Have We Come, and Where Do We Need to Go?

Wetmore

Liu

et al. 2016

CJASN

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The Healthy People 2020 initiative established goals for patients with CKD and ESRD. We assessed United States progress toward some of these key goals. Using data from the Centers for Medicare and Medicaid Services ESRD database, we created yearly cohorts of patients on incident and prevalent dialysis from 2000 to 2013. Change in event rate or proportion change over the study years was modeled using Poisson regression with adjustment for age, race, sex, and primary cause of ESRD. For all-cause mortality in prevalent patients, Healthy People 2020 sought approximately 0.8% relative annual improvement; actual improvement was 2.7%. Improvement was greatest for patients ages 18-44 years old (3.8%; P<0.01 versus 2.8% for ages 65-74 years old) and 2.3% even for patients ages ≥75 years old. For mortality in incident patients, the relative annual decrease was 2.1% overall, a twofold improvement over the goal; mortality decreased nearly twice as much in black as in white patients (3.2% versus 1.8%; P<0.001). Geographic variation was substantial; the relative annual decrease was 0.6% in the Midwest and more than fourfold greater (2.7%) in the South. Cardiovascular mortality in prevalent patients decreased dramatically at 5.0% per year, far exceeding the annual goal of approximately 0.8%; the decrease was greatest in patients ages ≥75 years old (5.5%; P<0.001 versus ages 65-74 years old; 5.1%). The relative annual increase in percentages of patients with a fistula at dialysis initiation was 2.4%, roughly three times the goal; the increase was greater for black than white patients (3.2% versus 2.3%; P<0.01). Adjusted regional differences varied greater than twofold: 2.0% for the South versus 4.1% for the Midwest. Thus, although gains have been substantial, not all groups have benefitted equally. Goal development for Healthy People 2030 should consider changes in goal paradigms, such as tailoring by geographic region and incorporating patient-centered goals.

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“…[133][134][135][136][137][138][139] Recent data indicate that although all-cause mortality rates in haemodialysis patients have been decreasing, the rates of SCD remain the same, indicative of an increased proportion of patients dying from SCD. 140 Risk of all-cause mortality is substantially higher in dialysis (15-20% at 1 year) than in heart failure or post-infarction patients (3-8% at 1 year). [140][141][142][143] Annual risk of SCD is higher in haemodialysis patients in comparison to other patient populations (Figure 4): 5-7% in haemodialysis patients, 4% in heart failure patients, and 1.5-2.7% in non-dialysis patients.…”

Section: Prevention Of Sudden Cardiac Deathmentioning

confidence: 97%

“…140 Risk of all-cause mortality is substantially higher in dialysis (15-20% at 1 year) than in heart failure or post-infarction patients (3-8% at 1 year). [140][141][142][143] Annual risk of SCD is higher in haemodialysis patients in comparison to other patient populations (Figure 4): 5-7% in haemodialysis patients, 4% in heart failure patients, and 1.5-2.7% in non-dialysis patients. The annual rates in non-dialysis patients are comparable to that of post-infarction patients.…”

Section: Prevention Of Sudden Cardiac Deathmentioning

confidence: 97%

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Chronic Kidney Disease and Arrhythmias: Conclusions From a Kidney Disease: Improving Global Outcomes (Kdigo) Controversies Conference

Carrero

Clase

Deo

et al. 2019

Nefrologiâ (St.-Peterbg.)

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Patients with chronic kidney disease (CKD) are predisposed to heart rhythm disorders, including atrial fibrillation (AF)/atrial flutter, supraventricular tachycardias, ventricular arrhythmias, and sudden cardiac death (SCD). While treatment options, including drug, device, and procedural therapies, are available, their use in the setting of CKD is complex and limited. Patients with CKD and end-stage kidney disease have historically been under-represented or excluded from randomized trials of arrhythmia treatment strategies, 1 although this situation is changing. Cardiovascular society consensus documents have recently identified evidence gaps for treating patients with CKD and heart rhythm disorders. To identify key issues relevant to the optimal prevention, management, and treatment of arrhythmias and their complications in patients with kidney disease, Kidney Disease: Improving Global Outcomes (KDIGO) convened an international, multidisciplinary Controversies Conference in Berlin, Germany, titled CKD and Arrhythmias in October 2016.

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Improving Outcomes in Patients Receiving Dialysis: The Peer Kidney Care Initiative

Cited by 20 publications

References 32 publications

Temporal Trends in Incident Mortality in Dialysis Patients: Focus on Sex and Racial Disparities

Temporal Trends in Incident Mortality in Dialysis Patients: Focus on Sex and Racial Disparities

The Healthy People 2020 Objectives for Kidney Disease: How Far Have We Come, and Where Do We Need to Go?

Chronic Kidney Disease and Arrhythmias: Conclusions From a Kidney Disease: Improving Global Outcomes (Kdigo) Controversies Conference

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