title: Specialist care and improved long-term survival of dialysis patients.
abstract: BACKGROUND
  The quality of dialysis care provided by specialists is expected to be superior to that by nonspecialists. However, little is known about the actual effect of specialist care on long-term prognosis in dialysis patients. We sought to determine whether specialist care can actually be associated with better survival rates in a nationwide Japanese dialysis cohort.
  
  
  METHODS
  The Japanese Society for Dialysis Therapy (JSDT) has annually reported clinical and demographic variables of dialysis patients for each prefecture in Japan since 1983. We analysed the data for the 47 prefectures from 1983 to 2006 to evaluate the relationship between the proportion of specialists and the cumulative survival rates for 5-year periods.
  
  
  RESULTS
  Trend analyses revealed that a higher quintile of specialists was associated with a better cumulative survival rate at 5-, 10-, 15- and 20-year periods. Univariate analyses for the 47 prefectures showed a higher proportion of specialists to be correlated with a better cumulative survival at 10-, 15- and 20-year periods. Multivariate analyses revealed that the proportion of specialists persisted as an independent contributor for better survival at 10-, 15- and 20-year periods even after adjustment for age, sex, diabetes mellitus and socioeconomical status, while the survival rate at 5 years was at a nonsignificant level.
  
  
  CONCLUSIONS
  While our study should be confirmed using data for individuals, this was not possible due to privacy issues. Therefore, based on our current findings, we conclude that for patients on maintenance dialysis, specialist care can be associated with better survival rates, particularly with longer follow-up.
authors.affiliation: Department of Geriatric Medicine and Nephrology, Osaka University Graduate School of Medicine, Osaka, Japan.
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Furumatsu
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Nagasawa
authors.forename: Ryohei
authors.initials: R
authors.lastname: Yamamoto
authors.forename: Kenichiro
authors.initials: K
authors.lastname: Iio
authors.forename: Hirotsugu
authors.initials: H
authors.lastname: Iwatani
authors.forename: Isao
authors.initials: I
authors.lastname: Matsui
authors.forename: Yoshitsugu
authors.initials: Y
authors.lastname: Takabatake
authors.forename: Noritaka
authors.initials: N
authors.lastname: Kawada
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Shoji
authors.forename: Enyu
authors.initials: E
authors.lastname: Imai
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Isaka
authors.forename: Hiromi
authors.initials: H
authors.lastname: Rakugi
mesh_terms: D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009398:Nephrology; D012044:Regression Analysis; D006435:Renal Dialysis; D015996:Survival Rate; D013997:Time Factors