BACKGROUND: The association of nephrologic care and survival in patients with diabetes mellitus and chronic kidney disease is unknown. METHODS: Using data from 1997 to 2000, we conducted a retrospective cohort study of Veterans Health Administration clinic users having diabetes mellitus and stage 3 or 4 chronic kidney disease. The baseline period was 12 months and median follow-up was 19.3 months. Degree of consistency of visits to a nephrologist, defined as the number of calendar quarters in which there was 1 visit or more (range, 0-4 quarters), and covariates were calculated from the baseline period. The outcome measure was dialysis-free death. RESULTS: Of 39,031 patients, 70.0%, 22.4%, and 7.6% had early stage 3, late stage 3, and stage 4 chronic kidney disease, respectively, and 3.1%, 9.5%, and 28.2%, respectively, visited a nephrologist. Dialysis-free mortality rates were 9.6, 14.1, and 19.4, respectively, per 100 person-years. More calendar quarters with visits to a nephrologist were associated with lower mortality: adjusted hazard ratios were 0.80 (95% confidence interval, 0.67-0.97), 0.68 (95% confidence interval, 0.55-0.86), and 0.45 (95% confidence interval, 0.32-0.63), respectively, when the groups having 2, 3, and 4 visits were compared with those who had no visits. One visit only was not associated with a difference in mortality when compared with no visits (adjusted hazard ratio,1.02; 95% confidence interval, 0.89-1.16). CONCLUSIONS: The consistency of outpatient nephrologic care was independently associated in a graded fashion with lower risk of deaths in patients with diabetes and moderately severe to severe chronic kidney disease. However, only a minority of patients had any visits to a nephrologist.
BACKGROUND: The association of nephrologic care and survival in patients with diabetes mellitus and chronic kidney disease is unknown. METHODS: Using data from 1997 to 2000, we conducted a retrospective cohort study of Veterans Health Administration clinic users having diabetes mellitus and stage 3 or 4 chronic kidney disease. The baseline period was 12 months and median follow-up was 19.3 months. Degree of consistency of visits to a nephrologist, defined as the number of calendar quarters in which there was 1 visit or more (range, 0-4 quarters), and covariates were calculated from the baseline period. The outcome measure was dialysis-free death. RESULTS: Of 39,031 patients, 70.0%, 22.4%, and 7.6% had early stage 3, late stage 3, and stage 4 chronic kidney disease, respectively, and 3.1%, 9.5%, and 28.2%, respectively, visited a nephrologist. Dialysis-free mortality rates were 9.6, 14.1, and 19.4, respectively, per 100 person-years. More calendar quarters with visits to a nephrologist were associated with lower mortality: adjusted hazard ratios were 0.80 (95% confidence interval, 0.67-0.97), 0.68 (95% confidence interval, 0.55-0.86), and 0.45 (95% confidence interval, 0.32-0.63), respectively, when the groups having 2, 3, and 4 visits were compared with those who had no visits. One visit only was not associated with a difference in mortality when compared with no visits (adjusted hazard ratio,1.02; 95% confidence interval, 0.89-1.16). CONCLUSIONS: The consistency of outpatient nephrologic care was independently associated in a graded fashion with lower risk of deaths in patients with diabetes and moderately severe to severe chronic kidney disease. However, only a minority of patients had any visits to a nephrologist.
Authors: Adrienne S Allen; John P Forman; E John Orav; David W Bates; Bradley M Denker; Thomas D Sequist Journal: J Gen Intern Med Date: 2010-10-05 Impact factor: 5.128
Authors: Edward D Siew; Josh F Peterson; Svetlana K Eden; Adriana M Hung; Theodore Speroff; T Alp Ikizler; Michael E Matheny Journal: J Am Soc Nephrol Date: 2011-12-08 Impact factor: 10.121
Authors: Hua Hao; Brendan P Lovasik; Stephen O Pastan; Howard H Chang; Ritam Chowdhury; Rachel E Patzer Journal: Kidney Int Date: 2015-04-22 Impact factor: 10.612
Authors: Ai-Hua Zhang; Paul Tam; Denise LeBlanc; Hui Zhong; Christopher T Chan; Joanne M Bargman; Dimitrios G Oreopoulos Journal: Int Urol Nephrol Date: 2009-07-04 Impact factor: 2.370
Authors: Guofen Yan; Alfred K Cheung; Jennie Z Ma; Alison J Yu; Tom Greene; M Norman Oliver; Wei Yu; Keith C Norris Journal: Clin J Am Soc Nephrol Date: 2013-03-14 Impact factor: 8.237