Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Early evaluation critical for kidney disease patients’ survival

17.09.2002


"We need to get (chronic kidney disease) on the radar screen, especially when there’s a medical history of high blood pressure or diabetes, so both patients and physicians are more aware of the consequences and opportunities to intervene." - Neil R. Powe, M.D., M.P.H.



Kidney disease patients are at a much increased risk of death when they have delays getting to a specialist, a Johns Hopkins-led study shows. Delays occur more often among black males, the uninsured and those who have multiple illnesses.

Results of the study, published in the Sept. 17 issue of the Annals of Internal Medicine, show that a third of chronic kidney disease patients were evaluated by a nephrologist only four months before having to start life-saving dialysis treatment. Those evaluated late were more likely to die within two years after starting dialysis. Delayed evaluation typically is associated with a higher risk of unplanned first dialysis and complications as well as increased hospital costs and length of stay.


While the study did not examine reasons for the delay in getting specialty care, senior author Neil R. Powe, M.D., M.P.H., M.B.A., says these probably include poor access to primary care, delayed or absent referral to a specialist from a primary care doctor and patients’ lack of information about the importance of early intervention.

"There also are many people who have chronic kidney disease and may not know it, so they may not be under a physician’s care," says Powe, director of Hopkins’ Welch Center for Prevention, Epidemiology and Clinical Research. "We need to get the condition on the radar screen, especially when there’s a medical history of high blood pressure or diabetes, so both patients and physicians are more aware of the consequences and opportunities to intervene. These patients should be under the care of a doctor and should talk to their doctors about seeing a nephrologist before their disease progresses to the point at which they need dialysis."

Powe and colleagues examined data from the Choices for Healthy Outcomes in Caring for End-stage renal disease (CHOICE) Study, a Hopkins effort that followed more than 1,000 dialysis patients nationwide between October 1995 and June 1998. For this study, they reviewed information on 828 patients just starting dialysis, asking them to complete a questionnaire on their medical and social history and provide the month and year in which they first visited a nephrologist.

They also compared the time between each patient’s first visit to a nephrologist and the start of his or her dialysis program. They defined early evaluation as first seeing a nephrologist more than a year before the start of dialysis and late evaluation as first seeing a nephrologist less than four months before dialysis. Patient survival rates were tracked for two years.

Thirty percent of patients were seen by a nephrologist less than four months prior to starting dialysis, compared to 22 percent evaluated between four and 12 months before dialysis, and 48 percent evaluated more than a year before dialysis. Late evaluation was more common among black men than white men (45 percent versus 25 percent), uninsured patients than insured patients (57 percent versus 29 percent) and patients with severe co-existing disease than those with mild or no co-existing disease (35 percent versus 23 percent). Those evaluated late were less likely to have received erythropoeitin, a hormone necessary to boost red blood cell production.

During an average follow-up period of 2.2 years, 201 of the patients died. Among those who were evaluated late, death rates were 13 percent one year after starting dialysis and 28 percent two years after starting dialysis. By comparison, among those evaluated early, the death rates were 4 percent and 15 percent, respectively.

Approximately 8 million people in the United States have moderate kidney disease, and another 300,000 have end-stage renal disease (ESRD), Powe says. Annual U.S. spending related to treatment of ESRD exceeds $15 billion. The patient population studied was 55 percent male, 28 percent black and 65 percent younger than age 65.

Karen Blum | EurekAlert!

More articles from Health and Medicine:

nachricht Biofilm discovery suggests new way to prevent dangerous infections
23.05.2017 | University of Texas at Austin

nachricht Another reason to exercise: Burning bone fat -- a key to better bone health
19.05.2017 | University of North Carolina Health Care

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Turmoil in sluggish electrons’ existence

An international team of physicists has monitored the scattering behaviour of electrons in a non-conducting material in real-time. Their insights could be beneficial for radiotherapy.

We can refer to electrons in non-conducting materials as ‘sluggish’. Typically, they remain fixed in a location, deep inside an atomic composite. It is hence...

Im Focus: Wafer-thin Magnetic Materials Developed for Future Quantum Technologies

Two-dimensional magnetic structures are regarded as a promising material for new types of data storage, since the magnetic properties of individual molecular building blocks can be investigated and modified. For the first time, researchers have now produced a wafer-thin ferrimagnet, in which molecules with different magnetic centers arrange themselves on a gold surface to form a checkerboard pattern. Scientists at the Swiss Nanoscience Institute at the University of Basel and the Paul Scherrer Institute published their findings in the journal Nature Communications.

Ferrimagnets are composed of two centers which are magnetized at different strengths and point in opposing directions. Two-dimensional, quasi-flat ferrimagnets...

Im Focus: World's thinnest hologram paves path to new 3-D world

Nano-hologram paves way for integration of 3-D holography into everyday electronics

An Australian-Chinese research team has created the world's thinnest hologram, paving the way towards the integration of 3D holography into everyday...

Im Focus: Using graphene to create quantum bits

In the race to produce a quantum computer, a number of projects are seeking a way to create quantum bits -- or qubits -- that are stable, meaning they are not much affected by changes in their environment. This normally needs highly nonlinear non-dissipative elements capable of functioning at very low temperatures.

In pursuit of this goal, researchers at EPFL's Laboratory of Photonics and Quantum Measurements LPQM (STI/SB), have investigated a nonlinear graphene-based...

Im Focus: Bacteria harness the lotus effect to protect themselves

Biofilms: Researchers find the causes of water-repelling properties

Dental plaque and the viscous brown slime in drainpipes are two familiar examples of bacterial biofilms. Removing such bacterial depositions from surfaces is...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

AWK Aachen Machine Tool Colloquium 2017: Internet of Production for Agile Enterprises

23.05.2017 | Event News

Dortmund MST Conference presents Individualized Healthcare Solutions with micro and nanotechnology

22.05.2017 | Event News

Innovation 4.0: Shaping a humane fourth industrial revolution

17.05.2017 | Event News

 
Latest News

Scientists propose synestia, a new type of planetary object

23.05.2017 | Physics and Astronomy

Zap! Graphene is bad news for bacteria

23.05.2017 | Life Sciences

Medical gamma-ray camera is now palm-sized

23.05.2017 | Medical Engineering

VideoLinks
B2B-VideoLinks
More VideoLinks >>>