Atherosclerotic renovascular disease in older US patients starting dialysis, 1996 to 2001.
BACKGROUND
Temporal trends regarding the epidemiology of atherosclerotic renovascular disease (ARVD) in dialysis populations are poorly defined.


RESULTS
United States Renal Data System data were used to identify patients aged 67 years or older at dialysis inception between 1996 and 2001 (n=146,973). Medicare claims in the preceding 2 years were used to identify ARVD and revascularization procedures. Prior ARVD rose from 7.1% to 11.2% between 1996 and 2001 (adjusted odds ratio [AOR], 1.68). Other associations included hypertensive end-stage renal disease (ESRD; AOR, 2.21), ESRD network (AOR, 0.44 in network 17 versus 1.00 in network 1), peripheral vascular disease (AOR, 1.65), black race (AOR, 0.44), urologic cause of ESRD (AOR, 0.57), age >85 years (AOR, 0.58), substance dependency (AOR, 0.62), and inability to ambulate or transfer (AOR, 0.67). The proportion of ARVD patients undergoing revascularization rose from 14.6% to 16.7% between 1996 and 2001 (AOR, 1.27). Other associations included hypertension (AOR, 2.10), ESRD network (AOR, 2.07 for network 13 versus 1.00 in network 1), age >85 years (AOR, 0.53), and black race (AOR, 0.54). The rise in ARVD was not reflected in the proportion of patients with renovascular disease listed as cause of ESRD on the Medical Evidence Report at dialysis inception (5.5% in 1996, 5.0% in 2001).


CONCLUSIONS
ARVD diagnoses have become more common in older patients beginning dialysis therapy. The association of demographic factors including age, race, and geographic residence with utilization patterns suggests possible barriers to care.
Guo
Haifeng
H
United States Renal Data System Coordinating Center, Minneapolis, MN 55404, USA.
Kalra
Philip A
PA
Gilbertson
David T
DT
Liu
Jiannong
J
Chen
Shu-Cheng
SC
Collins
Allan J
AJ
Foley
Robert N
RN
D000368:Aged; D000369:Aged, 80 and over; D050197:Atherosclerosis / Q000150:complications / Q000453:epidemiology* / Q000628:therapy; D016208:Databases, Factual / Q000639:trends; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000453:epidemiology* / Q000628:therapy; D008297:Male; D006278:Medicare / Q000639:trends; D006435:Renal Dialysis / Q000639:trends*; D014481:United States / Q000453:epidemiology