Journal of the American Society of Nephrology
2007 JASN IMPACT FACTOR 7.111 HOME   AUTHOR INFO   EDITORIAL BOARD   SUBSCRIBE   FEEDBACK   ALERTS   HELP 
    advanced
CURRENT ISSUE ARCHIVES JASN Express ONLINE SUBMISSION


This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by OBRADOR, G. T.
Right arrow Articles by PEREIRA, B. J. G.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by OBRADOR, G. T.
Right arrow Articles by PEREIRA, B. J. G.
J Am Soc Nephrol 10:1793-1800, 1999
© 1999 American Society of Nephrology

REGULAR ARTICLES

Prevalence of and Factors Associated with Suboptimal Care before Initiation of Dialysis in the United States

GREGORIO T. OBRADOR*, ROBIN RUTHAZER{dagger}, PRADEEP ARORA*, ANNAMARIA T. KAUSZ* and BRIAN J. G. PEREIRA*

* Division of Nephrology New England Medical Center, Boston, Massachusetts.
{dagger} Division of Clinical Care Research, New England Medical Center, Boston, Massachusetts.

Correspondence to Dr. Brian J. G. Pereira, Division of Nephrology, New England Medical Center, Box # 391, 750 Washington Street, Boston, MA 02111. Phone: 617-636-0372; Fax: 617-638-8329; E-mail: brian.pereira{at}es.nemc.org

Abstract

Abstract. Despite improvements in dialysis care, the mortality of patients with end-stage renal disease (ESRD) in the United States remains high. Factors that thus far have received scant attention, but could significantly affect morbidity and mortality in dialysis patients, are the timing and quality of care before the initiation of dialysis (pre-ESRD). Data from the new version of the Health Care Financing Administration (HCFA) 2728 Form were used to examine the prevalence of and factors associated with hypoalbuminemia, severe anemia, and erythropoietin (EPO) use among 155,076 incident chronic dialysis patients in the United States between April 1, 1995 and June 30, 1997. At initiation of dialysis, the median serum albumin and hematocrit were 3.3 g/dl and 28%, respectively. Sixty percent of patients had a serum albumin below the lower limit of normal and 51% had a hematocrit <28%. Overall, only 23% had received EPO pre-ESRD. Among patients with hematocrit <28%, only 20% were receiving EPO, compared to 27% among patients with hematocrit >=28%. In a multivariate analysis that adjusted for diabetes, functional status, and demographic, socioeconomic, and geographic factors, the odds ratios for hypoalbuminemia, hematocrit <28%, and lack of EPO use were higher for African-Americans, patients with non-private insurance or no insurance, and patients who were started on hemodialysis. There were also significant differences in odds ratios for these outcomes between different geographic regions in the United States. The high prevalence of pre-ESRD hypoalbuminemia, hematocrit <28%, and lack of EPO use suggests that the quality of pre-ESRD care in the United States is suboptimal. Improvement in pre-ESRD care could potentially improve outcomes among ESRD patients.




This article has been cited by other articles:


Home page
 J. Am. Soc. Nephrol.Home page
B. S. Spinowitz, A. T. Kausz, J. Baptista, S. D. Noble, R. Sothinathan, M. V. Bernardo, L. Brenner, and B. J. G. Pereira
Ferumoxytol for Treating Iron Deficiency Anemia in CKD
J. Am. Soc. Nephrol., August 1, 2008; 19(8): 1599 - 1605.
[Abstract] [Full Text] [PDF]

Home page
 Nephrol Dial TransplantHome page
F. Artunc and T. Risler
Serum erythropoietin concentrations and responses to anaemia in patients with or without chronic kidney disease
Nephrol. Dial. Transplant., October 1, 2007; 22(10): 2900 - 2908.
[Abstract] [Full Text] [PDF]

Home page
 Arch Intern MedHome page
M. M. Ward
Laboratory Abnormalities at the Onset of Treatment of End-Stage Renal Disease: Are There Racial or Socioeconomic Disparities in Care?
Arch Intern Med, May 28, 2007; 167(10): 1083 - 1091.
[Abstract] [Full Text] [PDF]

Home page
 J. Am. Soc. Nephrol.Home page
T. D. DuBose Jr.
American Society of Nephrology Presidential Address 2006: Chronic Kidney Disease as a Public Health Threat--New Strategy for a Growing Problem
J. Am. Soc. Nephrol., April 1, 2007; 18(4): 1038 - 1045.
[Full Text] [PDF]

Home page
 Am J Health Syst PharmHome page
W. J. Spruill, W. E. Wade, and H. H. Cobb III
Estimating glomerular filtration rate with a modification of diet in renal disease equation: Implications for pharmacy
Am. J. Health Syst. Pharm., March 15, 2007; 64(6): 652 - 660.
[Full Text] [PDF]

Home page
 CJASNHome page
A. S. Levey, S. P. Andreoli, T. DuBose, R. Provenzano, and A. J. Collins
Chronic Kidney Disease: Common, Harmful, and Treatable--World Kidney Day 2007
Clin. J. Am. Soc. Nephrol., March 1, 2007; 2(2): 401 - 405.
[Full Text] [PDF]

Home page
 The Annals of PharmacotherapyHome page
W. E Wade and W. J Spruill
New Serum Creatinine Assay Standardization: Implications for Drug Dosing
Ann. Pharmacother., March 1, 2007; 41(3): 475 - 480.
[Abstract] [Full Text] [PDF]

Home page
 J. Am. Soc. Nephrol.Home page
A. S. Levey, S. P. Andreoli, T. DuBose, R. Provenzano, and A. J. Collins
Chronic Kidney Disease: Common, Harmful, and Treatable--World Kidney Day 2007
J. Am. Soc. Nephrol., February 1, 2007; 18(2): 374 - 378.
[Full Text] [PDF]

Home page
 J. Am. Soc. Nephrol.Home page
S. I. Hallan, J. Coresh, B. C. Astor, A. Asberg, N. R. Powe, S. Romundstad, H. A. Hallan, S. Lydersen, and J. Holmen
International Comparison of the Relationship of Chronic Kidney Disease Prevalence and ESRD Risk
J. Am. Soc. Nephrol., August 1, 2006; 17(8): 2275 - 2284.
[Abstract] [Full Text] [PDF]

Home page
 NEJMHome page
L. A. Stevens, J. Coresh, T. Greene, and A. S. Levey
Assessing kidney function--measured and estimated glomerular filtration rate.
N. Engl. J. Med., June 8, 2006; 354(23): 2473 - 2483.
[Full Text] [PDF]

Home page
 J. Am. Soc. Nephrol.Home page
A. T. Kausz, H. Guo, B. J.G. Pereira, A. J. Collins, and D. T. Gilbertson
General Medical Care among Patients with Chronic Kidney Disease: Opportunities for Improving Outcomes
J. Am. Soc. Nephrol., October 1, 2005; 16(10): 3092 - 3101.
[Abstract] [Full Text] [PDF]

Home page
 Nephrol Dial TransplantHome page
J.-P. Wauters, N. Lameire, A. Davison, and E. Ritz
Why patients with progressing kidney disease are referred late to the nephrologist: on causes and proposals for improvement
Nephrol. Dial. Transplant., March 1, 2005; 20(3): 490 - 496.
[Full Text] [PDF]

Home page
 Clin. Chem.Home page
W. Koenig, D. Twardella, H. Brenner, and D. Rothenbacher
Plasma Concentrations of Cystatin C in Patients with Coronary Heart Disease and Risk for Secondary Cardiovascular Events: More than Simply a Marker of Glomerular Filtration Rate
Clin. Chem., February 1, 2005; 51(2): 321 - 327.
[Abstract] [Full Text] [PDF]

Home page
 Nephrol Dial TransplantHome page
B. M. Curtis, P. Ravani, F. Malberti, F. Kennett, P. A. Taylor, O. Djurdjev, and A. Levin
The short- and long-term impact of multi-disciplinary clinics in addition to standard nephrology care on patient outcomes
Nephrol. Dial. Transplant., January 1, 2005; 20(1): 147 - 154.
[Abstract] [Full Text] [PDF]

Home page
 J. Am. Soc. Nephrol.Home page
S. Beddhu, M. H. Samore, M. S. Roberts, G. J. Stoddard, N. Ramkumar, L. M. Pappas, and A. K. Cheung
Impact of Timing of Initiation of Dialysis on Mortality
J. Am. Soc. Nephrol., September 1, 2003; 14(9): 2305 - 2312.
[Abstract] [Full Text] [PDF]

Home page
 Nephrol Dial TransplantHome page
A. Levin
The advantage of a uniform terminology and staging system for chronic kidney disease (CKD)
Nephrol. Dial. Transplant., August 1, 2003; 18(8): 1446 - 1451.
[Full Text] [PDF]

Home page
 Nephrol Dial TransplantHome page
A. Levin
The advantage of a uniform terminology and staging system for chronic kidney disease (CKD)
Nephrol. Dial. Transplant., August 1, 2003; 18(88): 1446 - 1451.
[Full Text]

Home page
 ANN INTERN MEDHome page
A. S. Levey, J. Coresh, E. Balk, A. T. Kausz, A. Levin, M. W. Steffes, R. J. Hogg, R. D. Perrone, J. Lau, and G. Eknoyan
National Kidney Foundation Practice Guidelines for Chronic Kidney Disease: Evaluation, Classification, and Stratification
Ann Intern Med, July 15, 2003; 139(2): 137 - 147.
[Abstract] [Full Text] [PDF]

Home page
 Nephrol Dial TransplantHome page
A. J. Collins
Anaemia management prior to dialysis: cardiovascular and cost-benefit observations
Nephrol. Dial. Transplant., June 1, 2003; 18(suppl_2): ii2 - ii6.
[Abstract] [Full Text] [PDF]

Home page
 Med Care Res RevHome page
J. Hadley
Sicker and Poorer--The Consequences of Being Uninsured: A Review of the Research on the Relationship between Health Insurance, Medical Care Use, Health, Work, and Income
Med Care Res Rev, June 1, 2003; 60(2_suppl): 3S - 75S.
[Abstract] [PDF]

Home page
 Nephrol Dial TransplantHome page
F. Valderrabano, W. H. Horl, I. C. Macdougall, J. Rossert, B. Rutkowski, and J.-P. Wauters
PRE-dialysis survey on anaemia management
Nephrol. Dial. Transplant., January 1, 2003; 18(1): 89 - 100.
[Abstract] [Full Text] [PDF]

Home page
 ANN INTERN MEDHome page
K. S. Kinchen, J. Sadler, N. Fink, R. Brookmeyer, M. J. Klag, A. S. Levey, and N. R. Powe
The Timing of Specialist Evaluation in Chronic Kidney Disease and Mortality
Ann Intern Med, September 17, 2002; 137(6): 479 - 486.
[Abstract] [Full Text] [PDF]

Home page
 Nephrol Dial TransplantHome page
P.-Y. Jungers, C. Robino, G. Choukroun, T. Nguyen-Khoa, Z. A. Massy, and P. Jungers
Incidence of anaemia, and use of epoetin therapy in pre-dialysis patients: a prospective study in 403 patients
Nephrol. Dial. Transplant., September 1, 2002; 17(9): 1621 - 1627.
[Abstract] [Full Text] [PDF]

Home page
 Arch Intern MedHome page
B. C. Astor, P. Muntner, A. Levin, J. A. Eustace, and J. Coresh
Association of Kidney Function With Anemia: The Third National Health and Nutrition Examination Survey (1988-1994)
Arch Intern Med, June 24, 2002; 162(12): 1401 - 1408.
[Abstract] [Full Text] [PDF]

Home page
 Nephrol Dial TransplantHome page
P. Jungers
Late referral: loss of chance for the patient, loss of money for society
Nephrol. Dial. Transplant., March 1, 2002; 17(3): 371 - 375.
[Full Text] [PDF]

Home page
 Nephrol Dial TransplantHome page
A. Levin
The role of anaemia in the genesis of cardiac abnormalities in patients with chronic kidney disease
Nephrol. Dial. Transplant., February 1, 2002; 17(2): 207 - 210.
[Full Text] [PDF]

Home page
 J. Am. Soc. Nephrol.Home page
A. T. KAUSZ, S. S. KHAN, R. ABICHANDANI, W. H. KAZMI, G. T. OBRADOR, R. RUTHAZER, and B. J. G. PEREIRA
Management of Patients with Chronic Renal Insufficiency in the Northeastern United States
J. Am. Soc. Nephrol., July 1, 2001; 12(7): 1501 - 1507.
[Abstract] [Full Text] [PDF]

Home page
 Nephrol Dial TransplantHome page
I. Ledebo, M. Kessler, W. van Biesen, C. Wanner, A. Wiecek, S. Prichard, A. Argiles, and E. Ritz
Initiation of dialysis--opinions from an international survey: Report on the Dialysis Opinion Symposium at the ERA-EDTA Congress, 18 September 2000, Nice
Nephrol. Dial. Transplant., June 1, 2001; 16(6): 1132 - 1138.
[Full Text] [PDF]

Home page
 Nephrol Dial TransplantHome page
P. Jungers, G. Choukroun, C. Robino, Z. A. Massy, P. Taupin, M. Labrunie, N.-K. Man, and P. Landais
Epidemiology of end-stage renal disease in the Ile-de-France area: a prospective study in 1998
Nephrol. Dial. Transplant., December 1, 2000; 15(12): 2000 - 2006.
[Abstract] [Full Text] [PDF]

Home page
 J. Am. Soc. Nephrol.Home page
A. T. KAUSZ, G. T. OBRADOR, P. ARORA, R. RUTHAZER, A. S. LEVEY, and B. J. G. PEREIRA
Late Initiation of Dialysis among Women and Ethnic Minorities in the United States
J. Am. Soc. Nephrol., December 1, 2000; 11(12): 2351 - 2357.
[Abstract] [Full Text]


HOME CURRENT ISSUE ARCHIVES JASN Express ONLINE SUBMISSION AUTHOR INFO
EDITORIAL BOARD SUBSCRIBE FEEDBACK ALERTS HELP

Copyright © 2008 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673