BACKGROUND: Cardiovascular disease is the leading cause of increased mortality for adolescents with advanced kidney disease. The quality of preventive cardiovascular care may impact long-term outcomes for these patients. METHODS: We reviewed the records of 196 consecutive adolescents from eight centers with pre-dialysis chronic kidney disease, on dialysis or with a kidney transplant, who transferred to adult-focused providers. We compared cardiovascular risk assessment and therapy within and across centers. Predictors of care were assessed using multilevel models. RESULTS: Overall, 58 % (range 44-86 %; p = 0.08 for variance) of five recommended cardiovascular risk assessments were documented. Recommended therapy for six modifiable cardiovascular risk factors was documented 57 % (26-76 %; p = 0.09) of the time. Of these patients, 30 % (n = 59) were reported to go through formal transition which was independently associated with a 21 % increase in composite cardiovascular risk assessment (p < 0.001). Transfer after 2006 and kidney transplant status were also associated with increased cardiovascular risk assessment (p < 0.01 and p = 0.045, respectively). CONCLUSIONS: Adolescents with kidney disease receive suboptimal preventive cardiovascular care, that may contribute to their high risk of future cardiovascular mortality. A great opportunity exists to improve outcomes for children with kidney disease by improving the reliability of preventive care that may include formal transition programs.
BACKGROUND:Cardiovascular disease is the leading cause of increased mortality for adolescents with advanced kidney disease. The quality of preventive cardiovascular care may impact long-term outcomes for these patients. METHODS: We reviewed the records of 196 consecutive adolescents from eight centers with pre-dialysis chronic kidney disease, on dialysis or with a kidney transplant, who transferred to adult-focused providers. We compared cardiovascular risk assessment and therapy within and across centers. Predictors of care were assessed using multilevel models. RESULTS: Overall, 58 % (range 44-86 %; p = 0.08 for variance) of five recommended cardiovascular risk assessments were documented. Recommended therapy for six modifiable cardiovascular risk factors was documented 57 % (26-76 %; p = 0.09) of the time. Of these patients, 30 % (n = 59) were reported to go through formal transition which was independently associated with a 21 % increase in composite cardiovascular risk assessment (p < 0.001). Transfer after 2006 and kidney transplant status were also associated with increased cardiovascular risk assessment (p < 0.01 and p = 0.045, respectively). CONCLUSIONS: Adolescents with kidney disease receive suboptimal preventive cardiovascular care, that may contribute to their high risk of future cardiovascular mortality. A great opportunity exists to improve outcomes for children with kidney disease by improving the reliability of preventive care that may include formal transition programs.
Authors: B Kasiske; F G Cosio; J Beto; K Bolton; B M Chavers; R Grimm; A Levin; B Masri; R Parekh; C Wanner; D C Wheeler; P W F Wilson Journal: Am J Transplant Date: 2004 Impact factor: 8.086
Authors: Mark M Mitsnefes; Thomas R Kimball; William L Border; Sandra A Witt; Betty J Glascock; Philip R Khoury; Stephen R Daniels Journal: Am J Kidney Dis Date: 2004-04 Impact factor: 8.860
Authors: Blanche M Chavers; Julia T Molony; Craig A Solid; Michelle N Rheault; Allan J Collins Journal: Am J Nephrol Date: 2015-03-07 Impact factor: 3.754
Authors: Ahmad Kaddourah; Susan Uthup; Peace Madueme; Matthew O'Rourke; David K Hooper; Michael D Taylor; Steven D Colan; John L Jefferies; Marepalli B Rao; Jens Goebel Journal: Clin Nephrol Date: 2015-05 Impact factor: 0.975
Authors: Marcin Tkaczyk; Małgorzata Stańczyk; Monika Miklaszewska; Katarzyna Zachwieja; Ryszard Wierciński; Roman Stankiewicz; Agnieszka Firszt-Adamczyk; Jacek Zachwieja; Halina Borzęcka; Ilona Zagożdżon; Beata Leszczyńska; Anna Medyńska; Piotr Adamczyk; Maria Szczepańska; Wojciech Fendler Journal: Ren Fail Date: 2016-11-24 Impact factor: 2.606