Before starting dialysis, patients need nephrologist care

Dr. McClellan and colleagues analyzed data on more than 30,000 patients starting dialysis in five of the 18 US ESRD Network regions. The researchers evaluated the quality of the patients' medical care in the months before their CKD progressed to ESRD, and how that affected the patients' outcomes on dialysis.

Just over half of the patients received at least six months of pre-dialysis care from a nephrologist, as recommended by current guidelines. For these patients, the chances of surviving the first year on dialysis were about 50 percent higher than for patients who did not receive at least six months of nephrologist care. Survival rates were higher at dialysis centers where more patients received recommended care.

The researchers also unexpectedly discovered that dialysis centers with the lowest rates of recommended pre-dialysis care tended to be "clustered geographically." For example, there was a "significant circular cluster" of low pre-dialysis care centers located in Alabama and Mississippi.

Although the reasons for the geographic variations in care are unclear, the results identify specific regions that might benefit from efforts to improve care for advanced CKD patients. "The Centers for Medicare & Medicaid Services are currently conducting a pilot quality improvement initiative in ten states to determine the feasibility of such efforts," says Dr. McClellan.

More information: The study, entitled "Treatment Center and Geographic Variability in Pre-ESRD Care Associate with Increased Mortality," will appear online at http://jasn.asnjournals.org/ on Wednesday, March 25, 2009, doi 10.1681/ASN.2008060624.

Source: American Society of Nephrology (news : web)