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Snow KK, Patzer RE, Patel SA, Harding JL. County-Level Characteristics Associated with Variation in ESKD Mortality in the United States, 2010-2018. KIDNEY360 2022; 3:891-899. [PMID: 36128479 PMCID: PMC9438422 DOI: 10.34067/kid.0007872021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 02/25/2022] [Indexed: 01/10/2023]
Abstract
Background Geographic and neighborhood-level factors, such as poverty and education, have been associated with an increased risk for incident ESKD, likelihood of receiving pre-ESKD care, and likelihood of receiving a transplant. However, few studies have examined whether these same factors are associated with ESKD mortality. In this study, we examined county-level variation in ESKD mortality and identified county-level characteristics associated with this variation. Methods We identified 1,515,986 individuals (aged 18-84 years) initiating RRT (dialysis or transplant) between 2010 and 2018 using the United States Renal Data System. Among 2781 counties, we estimated county-level, all-cause, age-standardized mortality rates (ASMR) among patients with ESKD. We then identified county-level demographic (e.g., percent female), socioeconomic (e.g., percent unemployed), healthcare (e.g., percent without health insurance), and health behavior (e.g., percent current smokers) characteristics associated with ASMR using multivariable hierarchic linear mixed models and quantified the percentage of ASMR variation explained by county-level characteristics. Results County-level ESKD ASMR ranged from 45 to 1022 per 1000 person-years (PY) (mean, 119 per 1000 PY). ASMRs were highest in counties located in the Tennessee Valley and Appalachia regions, and lowest in counties located in New England, the Pacific Northwest, and Southern California. In fully adjusted models, county-level characteristics significantly associated with higher ESKD mortality included a lower percentage of Black residents (-4.94 per 1000 PY), lower transplant rate (-4.08 per 1000 PY), and higher healthcare expenditures (5.21 per 1000 PY). Overall, county-level characteristics explained 19% of variation in ESKD mortality. Conclusions Counties with high ESKD-related mortality may benefit from targeted and multilevel interventions that combine knowledge from a growing evidence base on the interplay between individual and community-level factors associated with ESKD mortality.
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Affiliation(s)
- Kylie K. Snow
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia,Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Rachel E. Patzer
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia,Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Shivani A. Patel
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Jessica L. Harding
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia,Department of Surgery, Emory University School of Medicine, Atlanta, Georgia,Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
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Robert T, Jantzen R, Cambier A, Jamme M, Couchoud C, Brunet P, Gentile S, Rondeau E, Mesnard L, Lapidus N. Spatiotemporal trends and prognosis of end-stage renal disease patients with biopsy-proven immunoglobulin A nephropathy in France from 2010 to 2014. Clin Kidney J 2020; 14:898-908. [PMID: 33777373 PMCID: PMC7986328 DOI: 10.1093/ckj/sfaa029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 01/28/2020] [Indexed: 12/01/2022] Open
Abstract
Background Although end-stage renal disease (ESRD) is frequently used as an outcome marker for primary immunoglobulin A nephropathy (IgAN), the clinical course after reaching ESRD is not well documented. This study examined patients’ characteristics and survival in ESRD-related biopsy-proven IgAN in France. Methods French Renal Epidemiology and Information Network Registry data from 2010 to 2014 were used to analyse patients’ survival and outcome in incident ESRD patients >16 years of age with biopsy-proven primary IgAN, in comparison with other primary and secondary glomerulonephritis (GN), adult polycystic kidney disease (ADPKD) or diabetes. Multivariable survival analysis was adjusted for age, sex, time on dialysis and comorbidities. Results Among 17 138 incident dialysis patients with ESRD, IgAN (242.8/10 000 dialysis initiation) represents the most common GN related to ESRD during 2010. IgAN patients were the youngest, and had the fewest comorbidities and the highest use of peritoneal dialysis (PD) (17%). In comparison with the haemodialysis group, hazard ratios for death were not different in the preemptive transplantation group [0.46, 95% confidence interval (CI) 0.17–1.28] and in the PD group (0.77, 95% CI 0.44–1.33). Mortality rates in IgAN patients with preemptive transplantation and in those receiving dialysis waiting for transplantation were 2.9% (95% CI 0.0–5.6) and 6.7% (95% CI 0.9–12.3). Mortality rates of ADPKD patients receiving dialysis waiting for transplantation were higher (18%, 95% CI 3.1–30.6). Conclusion IgAN has the best prognosis among primary and secondary GN. IgAN patients receiving dialysis waiting transplantation seem to have a more favourable prognosis than ADPKD patients, who usually comprise the reference population. The underlying reasons for the difference in access treatment modalities should be investigated to improve survival with respect to renal disease.
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Affiliation(s)
- Thomas Robert
- Department of Nephrology and Renal Transplantation, Assistance Publique-Hôpitaux de Marseille, Hôpital de la Conception, Marseille, France
| | - Rodolphe Jantzen
- Department of Public Health, Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique IPLESP, AP-HP, Saint-Antoine Hospital, Paris, France
| | - Alexandra Cambier
- Pediatric Department of Nephrology and Transplantation, Assistance Publique-Hôpitaux de Paris, Hôpital Robert-Debré, Paris, France
| | - Matthieu Jamme
- Department of Intensive Care Nephrology, Transplantation Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université Paris, Paris, France
| | - Cecile Couchoud
- REIN Registry, Agence de la Biomédecine, Saint-Denis la Plaine, France
| | - Philippe Brunet
- Department of Nephrology and Renal Transplantation, Assistance Publique-Hôpitaux de Marseille, Hôpital de la Conception, Marseille, France.,REIN Registry, Agence de la Biomédecine, Saint-Denis la Plaine, France
| | - Stéphanie Gentile
- Department of Nephrology and Renal Transplantation, Assistance Publique-Hôpitaux de Marseille, Hôpital de la Conception, Marseille, France.,REIN Registry, Agence de la Biomédecine, Saint-Denis la Plaine, France
| | - Eric Rondeau
- Department of Intensive Care Nephrology, Transplantation Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université Paris, Paris, France.,Université Pierre et Marie Curie, INSERM, IMR 1155, Hôpital Tenon, Paris, France
| | - Laurent Mesnard
- Department of Intensive Care Nephrology, Transplantation Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université Paris, Paris, France.,Université Pierre et Marie Curie, INSERM, IMR 1155, Hôpital Tenon, Paris, France
| | - Nathanael Lapidus
- Department of Public Health, Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique IPLESP, AP-HP, Saint-Antoine Hospital, Paris, France
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O'Shaughnessy MM, Montez-Rath ME, Lafayette RA, Winkelmayer WC. Patient characteristics and outcomes by GN subtype in ESRD. Clin J Am Soc Nephrol 2015; 10:1170-8. [PMID: 26092830 DOI: 10.2215/cjn.11261114] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 02/26/2015] [Indexed: 01/09/2023]
Abstract
BACKGROUND AND OBJECTIVES Outcomes-based research rarely focuses on patients with ESRD caused by GN. The hypotheses were that the GN subtype would clinically discriminate patient groups and independently associate with survival after ESRD therapy initiation. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Data were extracted from the US Renal Data System for adult patients with incident (1996-2011) ESRD attributed to six GN subtypes: FSGS, IgA nephropathy (IgAN), membranous nephropathy, membranoproliferative glomeruonephritis, lupus nephritis (LN), and vasculitis. ESRD attributed to diabetes and autosomal dominant polycystic kidney disease served as non-GN comparators. Unadjusted and adjusted mortality hazard ratios (aHRs) with 95% confidence intervals (95% CIs) were estimated using Cox regression (reference, IgAN). Models sequentially adjusted for sociodemographic (model 2), comorbidity/laboratory (model 3), and ESRD treatment modality (model 4) variables. RESULTS Among 84,301 patients with ESRD attributed to GN, the median age ranged from 39 (LN) to 66 (vasculitis) years, male sex ranged from 18% (LN) to 68% (IgAN), and black race ranged from 7% (IgAN) to 49% (LN). Patients with IgAN had the fewest comorbidities and lowest use of hemodialysis (70.1%). After a median follow-up of 2.5 (interquartile range, 1.0-4.9) years, crude mortality was lowest in IgAN (3.7 deaths/100 person years). Compared to IgAN, adjusted mortality was highest in LN (model 4 aHR=1.75; 95% CI, 1.68 to 1.83) and in diabetes (aHR=1.73; 95% CI, 1.67 to 1.79), and was also higher in all other GN subtypes (membranous nephropathy: aHR=1.23; 95% CI, 1.17 to 1.29; FSGS: aHR=1.37; 95% CI, 1.32 to 1.42; membranoproliferative GN: aHR=1.38; 95% CI, 1.31 to 1.45; vasculitis: aHR=1.51; 95% CI, 1.45 to 1.58) and in autosomal dominant polycystic kidney disease (aHR=1.22; 95% CI, 1.18 to 1.27). CONCLUSIONS This study exposes substantial heterogeneity across GN subtypes at ESRD therapy initiation and identifies independent associations between GN subtype and post-ESRD mortality. These survival discrepancies warrant further study, and the utility of current research practice to group GN subtypes together when evaluating ESRD outcomes should be questioned.
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Affiliation(s)
| | - Maria E Montez-Rath
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, California; and
| | - Richard A Lafayette
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, California; and
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Machado EL, Cherchiglia ML, Acúrcio FDA. Perfil e desfecho clínico de pacientes em lista de espera por transplante renal, Belo Horizonte (MG, Brasil), 2000-2005. CIENCIA & SAUDE COLETIVA 2011; 16:1981-92. [PMID: 21519686 DOI: 10.1590/s1413-81232011000300032] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2008] [Accepted: 06/10/2009] [Indexed: 11/22/2022] Open
Abstract
Trata-se de um estudo observacional, longitudinal, que teve como objetivo caracterizar o perfil dos pacientes inscritos na lista de espera para transplante renal entre 1º/01/2000 e 31/12/2004 em Belo Horizonte (MG) e seu desfecho clínico em 31/12/2005. Dados sociodemográficos e clínicos de pacientes residentes em Belo Horizonte, maiores de 18 anos, foram coletados na Central Estadual de Transplantes de MG. Realizaram-se entrevistas com profissionais vinculados ao processo regulatório de transplantes para relato das dificuldades de acesso a esse procedimento. Foram feitas análises descritivas, comparativas dos dados secundários e qualitativa das entrevistas. Inscreveram-se 835 pacientes. No final do estudo, 22,7% foram transplantados, 15,6% foram a óbito, 15,4% foram desligados e 46,2% permaneciam na fila de espera. Pacientes transplantados eram mais jovens e ativos profissionalmente, apresentaram mais frequentemente grupo sanguíneo A, glomerulonefrites como causa da insuficiência renal crônica, menor prevalência de diabetes e menor tempo do início da diálise à entrada na lista do que pacientes não transplantados. Variáveis sociodemográficas e clínicas influenciam o acesso ao transplante renal, considerado um processo complexo que tem determinantes desde a atenção básica até a obtenção do rim.
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Tomaszuk-Kazberuk A, Bachorzewska-Gajewska H, Malyszko J, Malyszko J, Mysliwiec M, Musial WJ. Impact of diabetes mellitus on survival in patients with end-stage renal disease: a three-year follow-up. Kidney Blood Press Res 2011; 34:83-6. [PMID: 21266825 DOI: 10.1159/000323894] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2010] [Accepted: 12/23/2010] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS To assess the impact of diabetes mellitus (DM) on clinical outcome in patients with end-stage renal disease (ESRD) on a 3-year follow-up. METHODS 58 ESRD patients were divided into 2 groups according to the presence of DM. We analyzed following end points: death, cardiac arrest, myocardial infarction, stroke, hospitalizations due to cardiovascular causes, revascularization, and combined end point. RESULTS Among diabetics, 14 (77.8%) had significant atherosclerotic changes, in the group without DM only 8 (38.1%), p = 0.01. In the group without DM, 14 (46.7%) patients reached combined end point, while in the group with DM 16 (53.3%) patients, p = 0.0013. There were no statistical differences in mortality (p = 0.423). CONCLUSION Survival of hemodialyzed diabetic patients is not inferior to nondiabetics; however, morbidity is significantly higher due to adverse cardiac events.
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Affiliation(s)
- Anna Tomaszuk-Kazberuk
- Department of Cardiology, Medical University, ul. Skłodowska-Curie 24A, Bialystok, Poland.
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Racki S, Zaputović L, Vujicić B, Crncević-Orlić Z, Dvornik S, Mavrić Z. Comparison of survival between diabetic and non-diabetic patients on maintenance hemodialysis: a single-centre experience. Diabetes Res Clin Pract 2007; 75:169-75. [PMID: 16824639 DOI: 10.1016/j.diabres.2006.05.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2006] [Accepted: 05/31/2006] [Indexed: 11/28/2022]
Abstract
We analyzed survival rates of 144 prevalent patients on maintenance hemodialysis from 1998 to 2003 at the Department of Nephrology and Dialysis, Rijeka University Hospital, Rijeka, Croatia, and evaluated risk factors predicting their survival. Included were only end-stage renal disease (ESRD) patients on maintenance hemodialysis treatment dialysed more than 6 months before entering the study and who were clinically stable. The patients were randomised in two groups according to the presence or absence of diabetic nephropathy as the cause of ESRD and followed-up. The patient's death as outcome measure was recorded. The survival rates were estimated by the Kaplan-Meier method. The major causes of death were cardiovascular disease in 40 (60.6%) patients. An acute myocardial infarction in 15 (22.7%) patients was the major single cause of death. We found a significantly lower survival of diabetic patients than non-diabetic patients (P=0.0013). The most important predictors of death among diabetic patients on maintenance hemodialysis were hyperglycaemia (P<0.001), ischemic heart disease (P=0.004), hypercholesterolemia (P=0.013), and low delivered dialysis dose (P=0.013). The survival of diabetic patients undergoing hemodialysis was much worse than survival of non-diabetic patients. The cardiovascular disease remained the major cause of death in both groups. Early detection of pre-existing cardiovascular risk factors and diseases, and treatment of infections leading to sepsis, are of great importance, as they may influence the survival rates. Intensive management of diabetic patients is essential.
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Affiliation(s)
- Sanjin Racki
- Department of Nephrology and Dialysis, Rijeka University Hospital, T.Strizića 3, HR-51000 Rijeka, Croatia.
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