Impact of specialization of primary nephrologist on the care of pediatric hemodialysis patients.
BACKGROUND
Children with end-stage renal disease (ESRD) receiving hemodialysis may have their care overseen primarily by a pediatric nephrologist or internal medicine (IM) nephrologist.


METHODS
To examine specific clinical outcomes by nephrologist specialization, a cross-sectional analysis of demographic and clinical data collected in the 2002 ESRD Clinical Performance Measures Project was performed.


RESULTS
Of 653 pediatric patients meeting inclusion criteria, 27% were cared for by IM nephrologists, and 73%, by pediatric nephrologists. Pediatric nephrologists were significantly more likely than IM nephrologists to care for patients who were younger and of Hispanic ethnicity. Patients of pediatric compared with IM nephrologists also were more likely to have a congenital cause of ESRD, smaller body mass index, and longer time on dialysis therapy. No significant differences in achieving a mean Kt/V of 1.2 or greater or mean hemoglobin level of 11 g/dL or greater (> or =110 g/L) according to nephrologist specialization were observed. After adjustment for patient clinical characteristics, no significant difference in use of arteriovenous fistulae was observed. Patients cared for by pediatric nephrologists were less likely to achieve a mean serum albumin level of 4.0/3.7 g/dL (40/37 g/L; bromcresol green laboratory method/bromcresol purple laboratory method; adjusted odds ratio, 0.60; 95% confidence interval, 0.42 to 0.86). Patients cared for by pediatric nephrologists had significantly greater serum calcium levels, lower serum phosphate levels, and lower intact parathyroid hormone levels.


CONCLUSIONS
Using adult-focused clinical care targets, care provided by pediatric and IM nephrologists to pediatric patients receiving hemodialysis in the United States is similar. However, differences exist, and the significance of these differences requires further study.
Fadrowski
Jeffrey J
JJ
Division of Pediatric Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA. jfadrow1@jhmi.edu
Frankenfield
Diane L
DL
Friedman
Aaron L
AL
Warady
Bradley A
BA
Neu
Alicia M
AM
Fivush
Barbara A
BA
D000293:Adolescent; D000419:Albuminuria / Q000453:epidemiology / Q000209:etiology; D000740:Anemia / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D001166:Arteriovenous Shunt, Surgical / Q000706:statistics & numerical data; D002408:Catheters, Indwelling / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D006934:Hypercalcemia / Q000453:epidemiology / Q000209:etiology; D007223:Infant; D007388:Internal Medicine; D007674:Kidney Diseases / Q000151:congenital / Q000453:epidemiology; D007676:Kidney Failure, Chronic / Q000097:blood / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D007677:Kidney Function Tests; D008297:Male; D008657:Metabolic Clearance Rate; D009398:Nephrology; D010372:Pediatrics; D010758:Phosphorus / Q000097:blood; D006435:Renal Dialysis; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
D010758:Phosphorus