title: Prehemodialysis care by dietitians and first-year mortality after initiation of hemodialysis.
abstract: BACKGROUND
  Since January 2002, Medicare has provided payment for medical nutrition therapy for patients with chronic kidney disease. Few patients receive dietary counseling before end-stage renal disease onset; whether such counseling is associated with improved outcomes is unknown.
  
  
  METHODS
  Retrospective cohort analysis.
  
  
  METHODS
  Patients who initiated hemodialysis therapy on June 1, 2005, to May 31, 2007, in the United States for whom predialysis dietitian care was reported on the Centers for Medicare & Medicaid Services Medical Evidence Report.
  
  
  METHODS
  Dietitian care before end-stage renal disease onset.
  
  
  RESULTS
  Time to death.
  
  
  METHODS
  Propensity score for dietitian care calculated using logistic regression; Cox regression analysis used to compare time to death by predialysis dietitian care overall and stratified by tertiles of propensity score, adjusting for baseline characteristics.
  
  
  RESULTS
  Most patients (88%) received no dietitian care; 9% received dietitian care for 12 months or less, and 3% received dietitian care for more than 12 months before dialysis therapy initiation (total N = 156,440). Predialysis dietitian care was associated independently with higher albumin and lower total cholesterol levels at dialysis therapy initiation. There was evidence of an independent association between predialysis dietitian care for longer than 12 months and decreased mortality during the first year on dialysis therapy for the second tertile of propensity score. Adjusted mortality HRs were 1.16 (95% CI, 0.44-3.09; P = 0.8), 0.81 (95% CI, 0.71-0.93; P = 0.002), and 0.93 (95% CI, 0.86-1.01; P = 0.1) in the first, second, and third tertiles of propensity score, respectively.
  
  
  CONCLUSIONS
  Information for dietitian care was missing for 18.6% of Medical Evidence Reports and has low sensitivity; including only incident dialysis patients precluded evaluation of an association between dietitian care and chronic kidney disease progression; the observational design allowed the possibility of residual confounding.
  
  
  CONCLUSIONS
  Our study suggests an independent association between predialysis dietitian care for more than 12 months and lower mortality during the first year on dialysis therapy.
authors: Veterans Administration Medical Center, Minneapolis, MN 55417, USA. slini001@umn.edu
authors: Yelena
authors: Y
authors: Slinin
authors: Haifeng
authors: H
authors: Guo
authors: David T
authors: DT
authors: Gilbertson
authors: Lih-Wen
authors: LW
authors: Mau
authors: Kristine
authors: K
authors: Ensrud
authors: Allan J
authors: AJ
authors: Collins
authors: Areef
authors: A
authors: Ishani
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000419:Albuminuria / Q000453:epidemiology; D002784:Cholesterol / Q000097:blood; D002908:Chronic Disease; D015897:Comorbidity; D003376:Counseling; D004046:Dietetics; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007674:Kidney Diseases / Q000097:blood / Q000178:diet therapy* / Q000628:therapy; D007676:Kidney Failure, Chronic / Q000097:blood / Q000401:mortality / Q000517:prevention & control / Q000628:therapy; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D006278:Medicare / Q000706:statistics & numerical data; D008875:Middle Aged; D011502:Protein-Energy Malnutrition / Q000453:epidemiology / Q000517:prevention & control; D006435:Renal Dialysis; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D002784:Cholesterol; D006442:Glycated Hemoglobin