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[IP] Mortality of Chronic Renal Disease Tied to Timing And Frequency of Nephrologist Care

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NEW YORK (Reuters Health) Sept 25, 2002 - The mortality rate of chronic
renal insufficiency during the first year of dialysis appears to be
influenced by when and how often a patient had visited a nephrologist before
starting dialysis, according to a report published in the September 23rd
issue of the Archives of Internal Medicine.
Earlier referral and more frequent visits are associated with a reduced risk
of death, lead author Dr. Jerry Avorn, from Brigham and Women's Hospital in
Boston, and colleagues note.

The current findings are in agreement with those of a recent study involving
patients with new-onset end-stage renal disease (see Reuters Health story
September 20, 2002). In that study, patients who were first evaluated by a
nephrologist less than 4 months prior to the start of dialysis were at
increased risk for death compared with patients evaluated earlier.

The present study included 3,014 patients with chronic renal insufficiency
who began dialysis between 1991 and 1996. All of the subjects were
participants in New Jersey Medicaid or Medicare programs and were diagnosed
with renal disease at least one year prior to undergoing dialysis.

Patients who first visited a nephrologist 90 days or less before the start
of dialysis were at a 37% increased risk for death during the first year of
dialysis compared with patients who saw a nephrologist earlier (p < 0.001).
Furthermore, patients who visited a nephrologist less than 5 times in the
year prior to dialysis had a 15% higher mortality rate than those who
visited a nephrologist more frequently (p = 0.01).

"If these findings are replicated in other settings, especially in younger
and less indigent cohorts, it will be important to further define the
mechanism through which early and/or more frequent nephrologist input
appears to have a beneficial effect on patient outcomes," the researchers

"If confirmed, such findings could have important implications for quality
improvement programs, manpower projections, the care of particular high-risk
populations, as well as healthy policy and resource allocation decisions,"
they add
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