title: Greater first-year survival on hemodialysis in facilities in which patients are provided earlier and more frequent pre-nephrology visits.
abstract: OBJECTIVE
  The aim of this study was to evaluate the relation between pre-nephrology visit (PNV) and 1-yr patient survival after hemodialysis (HD) induction.
  
  
  METHODS
  Data were analyzed from 8500 incident HD patients (on HD <or=30 d) in the Dialysis Outcomes and Practice Patterns Study (DOPPS) phases I and II. A visit to a nephrologist at least 1 mo before starting HD was regarded as PNV. Cox regression was used to estimate the adjusted hazard ratio (AHR) for mortality in the first year of HD in both patient- and facility-level analyses. All models were adjusted for age, sex, race, socioeconomic factors, cause of ESRD, 14 comorbid conditions, hemoglobin, serum albumin, and serum creatinine; accounted for facility clustering effects; and were stratified by country.
  
  
  RESULTS
  In patient-level analysis, PNV was associated with significantly lower risk for death (AHR 0.57; P < 0.0001). Facility-level analysis also showed a significant lower risk for death in facilities with greater prevalence of PNV in both continuous models (AHR 0.92 per 10% greater facility mean %PNV; P < 0.0004) and in categorical models (AHR 0.71 for facilities with >90% of patients receiving PNV [first quartile] compared with facilities with <71% of patients receiving PNV [fourth quartile]; P = 0.001).
  
  
  CONCLUSIONS
  These results provide not only patient-level but also facility practice evidence that PNV is related to improved patient survival during the first year after initiation of HD, indicating the possible mortality benefits with more increased attention to PNV.
authors.affiliation: Department of Epidemiology and Healthcare Research, Kyoto University Graduate School of Medicine and Public Health, Konoe-cho Yoshida, Kyoto, Japan. tahasegawa-npr@umin.net.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Hasegawa
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Bragg-Gresham
authors.forename: Shin
authors.initials: S
authors.lastname: Yamazaki
authors.forename: Shunichi
authors.initials: S
authors.lastname: Fukuhara
authors.forename: Tadao
authors.initials: T
authors.lastname: Akizawa
authors.forename: Werner
authors.initials: W
authors.lastname: Kleophas
authors.forename: Roger
authors.initials: R
authors.lastname: Greenwood
authors.forename: Ronald L
authors.initials: RL
authors.lastname: Pisoni
mesh_terms: D000368:Aged; D005060:Europe / Q000453:epidemiology; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006436:Hemodialysis Units, Hospital / Q000706:statistics & numerical data*; D006801:Humans; D007564:Japan / Q000453:epidemiology; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D016016:Proportional Hazards Models; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D006435:Renal Dialysis / Q000401:mortality*; D012111:Residence Characteristics; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology