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 Malaria Already Endemic in the Mediterranean by the Roman Period
27.07.2017 | Universität Zürich

nachricht Serious children’s infections also spreading in Switzerland
26.07.2017 | Universitätsspital Bern

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: Physicists Design Ultrafocused Pulses

Physicists working with researcher Oriol Romero-Isart devised a new simple scheme to theoretically generate arbitrarily short and focused electromagnetic fields. This new tool could be used for precise sensing and in microscopy.

Microwaves, heat radiation, light and X-radiation are examples for electromagnetic waves. Many applications require to focus the electromagnetic fields to...

Im Focus: Carbon Nanotubes Turn Electrical Current into Light-emitting Quasi-particles

Strong light-matter coupling in these semiconducting tubes may hold the key to electrically pumped lasers

Light-matter quasi-particles can be generated electrically in semiconducting carbon nanotubes. Material scientists and physicists from Heidelberg University...

Im Focus: Flexible proximity sensor creates smart surfaces

Fraunhofer IPA has developed a proximity sensor made from silicone and carbon nanotubes (CNT) which detects objects and determines their position. The materials and printing process used mean that the sensor is extremely flexible, economical and can be used for large surfaces. Industry and research partners can use and further develop this innovation straight away.

At first glance, the proximity sensor appears to be nothing special: a thin, elastic layer of silicone onto which black square surfaces are printed, but these...

Im Focus: 3-D scanning with water

3-D shape acquisition using water displacement as the shape sensor for the reconstruction of complex objects

A global team of computer scientists and engineers have developed an innovative technique that more completely reconstructs challenging 3D objects. An ancient...

Im Focus: Manipulating Electron Spins Without Loss of Information

Physicists have developed a new technique that uses electrical voltages to control the electron spin on a chip. The newly-developed method provides protection from spin decay, meaning that the contained information can be maintained and transmitted over comparatively large distances, as has been demonstrated by a team from the University of Basel’s Department of Physics and the Swiss Nanoscience Institute. The results have been published in Physical Review X.

For several years, researchers have been trying to use the spin of an electron to store and transmit information. The spin of each electron is always coupled...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

Clash of Realities 2017: Registration now open. International Conference at TH Köln

26.07.2017 | Event News

Closing the Sustainability Circle: Protection of Food with Biobased Materials

21.07.2017 | Event News

»We are bringing Additive Manufacturing to SMEs«

19.07.2017 | Event News

 
Latest News

Programming cells with computer-like logic

27.07.2017 | Life Sciences

Identified the component that allows a lethal bacteria to spread resistance to antibiotics

27.07.2017 | Life Sciences

Malaria Already Endemic in the Mediterranean by the Roman Period

27.07.2017 | Health and Medicine

VideoLinks
B2B-VideoLinks
More VideoLinks >>>