Original InvestigationsDeterminants of delayed nephrologist referral in patients with chronic kidney disease★
Section snippets
Patients
We identified all adult patients who began RRT from 1990 through mid-1996 who had been active participants in either the Medicare or Medicaid programs of the state of New Jersey for at least 12 months before the initiation of renal dialysis. These patients were identified using the International Classification of Diseases, Ninth Revision and Current Procedural Terminology codes for hemodialysis, PD, other dialysis, renal transplantation, and other ESRD services. We studied all patients aged 18
Population and patient characteristics
We identified 17,884 patients who underwent first RRT at some point during 1991 to 1996 (Fig 1). This cohort also included all patients who underwent one-time or short-term RRT as a consequence of acute renal failure. Of these patients, 12,557 had adequate baseline data for a full year before dialysis in Medicaid and/or Medicare to permit further study. In this population, 5,242 patients had their first renal diagnosis at least 1 year before
Discussion
We found that patients older than 74 years were much less likely to be referred to a nephrologist in a timely fashion. This confirms the earlier findings of Ifudu et al19 that patients older than 55 years were five times more likely to be referred late compared with patients aged ≤55 years. Khan et al20 found a similar result for patients older than 80 years in a cohort of patients in the United Kingdom, as did Eadington et al.21 It is possible that nonnephrologists underestimate the value of
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Cited by (107)
Modest rates and wide variation in timely access to repeat kidney transplantation in the United States
2020, American Journal of TransplantationRace and Mortality in CKD and Dialysis: Findings From the Chronic Renal Insufficiency Cohort (CRIC) Study
2020, American Journal of Kidney DiseasesResidential Area Life Expectancy: Association With Outcomes and Processes of Care for Patients With ESRD in the United States
2018, American Journal of Kidney DiseasesCitation Excerpt :Finally, we merged data with the 2013 National Center for Health Statistics to obtain the Urban-Rural Classification Scheme (categorized on a scale of 1-6 from most urban to rural) for counties based on the Office of Management and Budget.23 We evaluated several primary processes of care and outcomes for incident patients with ESRD.24,25 Processes of care of interest were derived from the Medicare 2728 form and included the following fields: “Has the patient been informed of kidney transplant options?,”
Chronic kidney disease referral practices among non-nephrology specialists: A single-centre experience
2016, European Journal of Internal MedicineCitation Excerpt :Females were concordantly less likely to be referred to a nephrologist in another study performed by Navaneethan et al., a finding which persisted even in the geriatric population (over 65 years) [9]. Winkelmayer WC et al. found no significant gender difference [10]. In contrast, Campbell et al. concluded that female gender was a factor which significantly increased the probability of referral [11].
Analysis of emergency Department Frequentation among patients with advanced CKD (chronic kidney disease): Lessons to optimize scheduled renal replacement therapy initiation
2018, NefrologiaCitation Excerpt :The KDIGO Guidelines6 emphasize the initiation of RRT in symptomatic patients and/or in the presence of a glomerular filtration rate (GFR) of 5–10 mL/min. In general, these situations result from late referral to the nephrologist.2,7–9 But this will not be our scenario; now will concentrate in patients being followed in of advanced chronic kidney disease outpatient clinics (ACKD).
Supported in part by grant no. R0-1-HS09398 from the Agency for Health Care Policy and Research and the Health Care Financing Administration.
Address reprint requests to Wolfgang C. Winkelmayer, MD, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, 221 Longwood Ave, BLI/341, Boston, MA 02115. E-mail: [email protected]
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