0

The full content of Annals is available to subscribers

Subscribe/Learn More  >
Articles |

The Timing of Specialist Evaluation in Chronic Kidney Disease and Mortality

Kraig S. Kinchen, MD, MSc; John Sadler, MD; Nancy Fink, MPH; Ronald Brookmeyer, PhD; Michael J. Klag, MD, MPH; Andrew S. Levey, MD; and Neil R. Powe, MD, MPH, MBA
[+] Article and Author Information

From the Robert Wood Johnson Clinical Scholars Program and Welch Center for Prevention, Epidemiology, and Clinical Research, The Johns Hopkins University School of Medicine, Independent Dialysis Foundation, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; and New England Medical Center, Boston, Massachusetts.


Acknowledgments: The authors thank the patients, staff, and medical directors of the participating clinics at Dialysis Clinic, Inc., New Haven CAPD, and St. Raphael's Hospital who contributed to the study.

Grant Support: The Choices for Healthy Outcomes in Caring for ESRD Study is supported by grant R01-HS-08365 from the Agency for Health Care Research and Quality, Rockville, Maryland, and by grant R01 DK59616 from the National Institute of Diabetes and Digestive and Kidney Diseases. Dr. Kinchen was supported by the Robert Wood Johnson Clinical Scholars Program, and Dr. Powe (grant K24DK02643) and Dr. Klag (by grant K24DK02856) received grants from the National Institute of Diabetes and Digestive and Kidney Diseases.

Requests for Single Reprints: Neil R. Powe, MD, MPH, MBA, Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, 2024 East Monument Street, Suite 2-600, Baltimore, MD 21205-2223; e-mail, npowe@jhmi.edu.

Current Author Addresses: Dr. Kinchen: Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46285.

Dr. Sadler: Independent Dialysis Foundation, 840 Hollins Street, Baltimore, MD 21201.

Dr. Fink: Johns Hopkins University, 2024 East Monument Street, Baltimore, MD 21205.

Dr. Brookmeyer: Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD 21205.

Dr. Klag: Johns Hopkins University, 2024 East Monument Street, Baltimore, MD 21205

Dr. Levey: Tufts-New England Medical Center, 750 Washington Street, Boston, MA 02111.

Dr. Powe: Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, 2024 East Monument Street, Suite 2-600, Baltimore, MD 21205-2223.

Author Contributions Conception and design: K.S. Kinchen, J. Sadler, N. Fink, M.J. Klag, A.S. Levey, N.R. Powe.

Analysis and interpretation of the data: K.S. Kinchen, R. Brookmeyer, A.S. Levey, N.R. Powe.

Drafting of the article: K.S. Kinchen, N. Fink, N.R. Powe.

Critical revision of the article for important intellectual content: K.S. Kinchen, J. Sadler, N. Fink, R. Brookmeyer, M.J. Klag, A.S. Levey, N.R. Powe.

Final approval of the article: K.S. Kinchen, N. Fink, M.J. Klag, A.S. Levey, N.R. Powe.

Statistical expertise: R. Brookmeyer, N.R. Powe.

Obtaining of funding: A.S. Levey, N.R. Powe.

Administrative, technical, or logistic support: N. Fink, N.R. Powe.

Collection and assembly of data: N. Fink, N.R. Powe.


Ann Intern Med. 2002;137(6):479-486. doi:10.7326/0003-4819-137-6-200209170-00007
Text Size: A A A

We studied a nationally representative sample of U.S. patients with incident, dialysis-dependent ESRD over a median of 2.2 years. Late evaluation of chronic kidney disease was a predictor of death after we controlled for type of dialysis, demographic characteristics, and socioeconomic factors. We also controlled for comorbid conditions by using the ICED, which reflects not only the diagnosis of at least one comorbid disease but the extent to which the disease is controlled. The ICED has been validated as a predictor of death in patients with ESRD (31). After adjustment for ICED score, the relationship between late evaluation and death was similar. Finally, when we adjusted for measures of renal function, hematocrit, and serum albumin level, the magnitude of the relationship increased. A graded relationship between timing of evaluation and mortality, in which hazard ratios increased from early to intermediate to late evaluation, was observed in all analyses.

First Page Preview

View Large
/>
First page PDF preview

Figures

Grahic Jump Location
Figure 1.
Time from first evaluation by a nephrologist to first dialysis.
Grahic Jump Location
Grahic Jump Location
Figure 2.
Cumulative mortality in patients undergoing early, intermediate, or late evaluation by a nephrologist. Top.Bottom.

Cumulative mortality in the total sample. Cumulative mortality in diabetic patients.

Grahic Jump Location

Tables

References

Letters

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Comments

Submit a Comment
Submit a Comment

Summary for Patients

Timing of Evaluation by Specialists for Patients with Chronic Kidney Disease

The summary below is from the full report titled “The Timing of Specialist Evaluation in Chronic Kidney Disease and Mortality.” It is in the 17 September 2002 issue of Annals of Internal Medicine (volume 137, pages 479-486). The authors are KS Kinchen, J Sadler, N Fink, R Brookmeyer, MJ Klag, AS Levey, and NR Powe.

Read More...

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.

Toolkit

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Advertisement
Related Articles
Related Point of Care
Topic Collections
PubMed Articles
Acute kidney injury in cardiac surgery. Rev Invest Clin 2013 Nov-Dec;65(6):467-75.

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.
(Required)
(Required)