Lower ESRD mortality seen with early nephrology care.

SAN FRANCISCO -- Patients treated by a nephrologist at least 12 months before their diagnosis of end-stage renal disease had 29% lower mortality during the first year after the diagnosis than did patients who had no nephrology care, according to a retrospective analysis of data on 52,277 patients.

Patients who had 0-6 months of pre-ESRD nephrology care had 19% lower mortality, and those with 6-12 months had 17% lower mortality, according to a poster presentation by Dr. Rajiv Saran at the annual meeting of the American Society of Nephrology.

About 60% of the patients had been seen by a nephrologist before their ESRD diagnosis. Only 23% had at least a year of pre-ESRD nephrology care.

Although 11% of the patients had pre-ESRD dietitian care and 32% had pre-ESRD erythropoietin (EPO) treatment, neither dietitian care nor EPO treatment prior to diagnosis showed a significant association with mortality, wrote Dr. Saran of the University of Michigan, Ann Arbor, and his colleagues.

The study included all new ESRD patients in the United States between June 1 and Dec. 31, 2005, who survived to day 90 of ESRD treatment. The study was possible because beginning in June 2005 the Centers for Medicare and Medicaid Services required that all new ESRD patients complete a Medical Evidence Form (CMS-2728). In addition to information on pre-ESRD care, the forms collect information on comorbidities, body mass index, hemoglobin, creatinine, albumin, modality of treatment, and vascular access.

The investigators followed patients from day 90 of ESRD until death, transplant, or day 365, whichever came first. The multivariate model was adjusted for age, race, ethnicity, sex, cause of the ESRD, comorbidity, BMI, glomerular filtration rate, hemoglobin, and albumin at the start of the ESRD.

African Americans, Hispanics, nondiabetics, and those with low albumin or low hemoglobin had especially low probabilities of early referral to a nephrologist.

The study was supported by a contract from the Centers for Medicare and Medicaid Services.

BY ROBERT FINN

San Francisco Bureau