title: Pre-Dialysis Visits to a Nephrology Department and Major Cardiovascular Events in Patients Undergoing Dialysis.
abstract: OBJECTIVE
  Pre-dialysis care by a nephrology out-patient department (OPD) may affect the outcomes of patients who ultimately undergo maintenance dialysis. This study examined the effect of pre-dialysis care by a nephrology OPD on the incidence of one-year major cardiovascular events after initiation of dialysis.
  
  
  METHODS
  The study consisted of Taiwanese patients with chronic kidney disease (CKD) who commenced dialysis from 2006 to 2008. The number of nephrology OPD visits during the critical care period (within 6 months of initiation of dialysis) and the early care period (6-36 months before initiation of dialysis) were analyzed. The primary outcome measure was one-year major cardiovascular events.
  
  
  RESULTS
  A total of 1191 CKD patients who initiated dialysis from 2006 to 2008 were included. Binary logistic regression showed that patients with ≧3 visits during the critical care period and those with ≧11 visits during the early care period had fewer composite major cardiovascular events than those with 0 visits. Patients with early referral are less likely to experience composite major cardiovascular events than those with late referral, with aOR 0.574 (95% CI = 0.43-0.77, P<0.001). Patients with both ≧3 visits during critical care period and ≧11 visits during early care period were less likely to experience composite major cardiovascular events (aOR = 0.25, 95% CI = 0.16-0.39, P < 0.001).
  
  
  CONCLUSIONS
  Patients with adequate pre-dialysis nephrology OPD visits, not just early referral, may had fewer one-year composite major cardiovascular events after initiation of dialysis. This information may be important to medical care providers and public health policy makers in their efforts to improve the well-being of CKD patients.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan.
authors.forename: Chih-Yuan
authors.initials: CY
authors.lastname: Huang
authors.affiliation: Department of Medical Research, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi, Taiwan.
authors.forename: Chia-Wen
authors.initials: CW
authors.lastname: Hsu
authors.affiliation: Department of Obstetrics and Gynecology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-yi, Taiwan.
authors.forename: Chi-Rou
authors.initials: CR
authors.lastname: Chuang
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.|School of Medicine, National Defense Medical Center, Taipei, Taiwan.
authors.forename: Ching-Chih
authors.initials: CC
authors.lastname: Lee
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D005260:Female; D006748:Hospital Departments / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D009398:Nephrology; D010045:Outpatients / Q000706:statistics & numerical data; D006435:Renal Dialysis / Q000706:statistics & numerical data*; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology* / Q000628:therapy; D012307:Risk Factors