title: The quality of cardiovascular disease care for adolescents with kidney disease: a Midwest Pediatric Nephrology Consortium study.
abstract: BACKGROUND
  Cardiovascular disease is the leading cause of increased mortality for adolescents with advanced kidney disease. The quality of preventive cardiovascular care may impact long-term outcomes for these patients.
  
  
  METHODS
  We reviewed the records of 196 consecutive adolescents from eight centers with pre-dialysis chronic kidney disease, on dialysis or with a kidney transplant, who transferred to adult-focused providers. We compared cardiovascular risk assessment and therapy within and across centers. Predictors of care were assessed using multilevel models.
  
  
  RESULTS
  Overall, 58 % (range 44-86 %; p = 0.08 for variance) of five recommended cardiovascular risk assessments were documented. Recommended therapy for six modifiable cardiovascular risk factors was documented 57 % (26-76 %; p = 0.09) of the time. Of these patients, 30 % (n = 59) were reported to go through formal transition which was independently associated with a 21 % increase in composite cardiovascular risk assessment (p < 0.001). Transfer after 2006 and kidney transplant status were also associated with increased cardiovascular risk assessment (p < 0.01 and p = 0.045, respectively).
  
  
  CONCLUSIONS
  Adolescents with kidney disease receive suboptimal preventive cardiovascular care, that may contribute to their high risk of future cardiovascular mortality. A great opportunity exists to improve outcomes for children with kidney disease by improving the reliability of preventive care that may include formal transition programs.
authors: Division of Nephrology & Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors: David K
authors: DK
authors: Hooper
authors: Jason C
authors: JC
authors: Williams
authors: Adam C
authors: AC
authors: Carle
authors: Sandra
authors: S
authors: Amaral
authors: Deepa H
authors: DH
authors: Chand
authors: Maria E
authors: ME
authors: Ferris
authors: Hiren P
authors: HP
authors: Patel
authors: Christoph
authors: C
authors: Licht
authors: Gina-Marie
authors: GM
authors: Barletta
authors: Veronica
authors: V
authors: Zitterman
authors: Mark
authors: M
authors: Mitsnefes
authors: Uptal D
authors: UD
authors: Patel
mesh_terms: D000293:Adolescent; D000328:Adult; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000150:complications*; D008297:Male; D011787:Quality of Health Care; D018570:Risk Assessment; D012307:Risk Factors