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 A whole-body approach to understanding chemosensory cells
13.12.2017 | Tokyo Institute of Technology

nachricht Research reveals how diabetes in pregnancy affects baby's heart
13.12.2017 | University of California - Los Angeles Health Sciences

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: Long-lived storage of a photonic qubit for worldwide teleportation

MPQ scientists achieve long storage times for photonic quantum bits which break the lower bound for direct teleportation in a global quantum network.

Concerning the development of quantum memories for the realization of global quantum networks, scientists of the Quantum Dynamics Division led by Professor...

Im Focus: Electromagnetic water cloak eliminates drag and wake

Detailed calculations show water cloaks are feasible with today's technology

Researchers have developed a water cloaking concept based on electromagnetic forces that could eliminate an object's wake, greatly reducing its drag while...

Im Focus: Scientists channel graphene to understand filtration and ion transport into cells

Tiny pores at a cell's entryway act as miniature bouncers, letting in some electrically charged atoms--ions--but blocking others. Operating as exquisitely sensitive filters, these "ion channels" play a critical role in biological functions such as muscle contraction and the firing of brain cells.

To rapidly transport the right ions through the cell membrane, the tiny channels rely on a complex interplay between the ions and surrounding molecules,...

Im Focus: Towards data storage at the single molecule level

The miniaturization of the current technology of storage media is hindered by fundamental limits of quantum mechanics. A new approach consists in using so-called spin-crossover molecules as the smallest possible storage unit. Similar to normal hard drives, these special molecules can save information via their magnetic state. A research team from Kiel University has now managed to successfully place a new class of spin-crossover molecules onto a surface and to improve the molecule’s storage capacity. The storage density of conventional hard drives could therefore theoretically be increased by more than one hundred fold. The study has been published in the scientific journal Nano Letters.

Over the past few years, the building blocks of storage media have gotten ever smaller. But further miniaturization of the current technology is hindered by...

Im Focus: Successful Mechanical Testing of Nanowires

With innovative experiments, researchers at the Helmholtz-Zentrums Geesthacht and the Technical University Hamburg unravel why tiny metallic structures are extremely strong

Light-weight and simultaneously strong – porous metallic nanomaterials promise interesting applications as, for instance, for future aeroplanes with enhanced...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

See, understand and experience the work of the future

11.12.2017 | Event News

Innovative strategies to tackle parasitic worms

08.12.2017 | Event News

AKL’18: The opportunities and challenges of digitalization in the laser industry

07.12.2017 | Event News

 
Latest News

A whole-body approach to understanding chemosensory cells

13.12.2017 | Health and Medicine

Water without windows: Capturing water vapor inside an electron microscope

13.12.2017 | Physics and Astronomy

Cellular Self-Digestion Process Triggers Autoimmune Disease

13.12.2017 | Life Sciences

VideoLinks
B2B-VideoLinks
More VideoLinks >>>