title: Predialysis nephrology care and dialysis-related health outcomes among older adults initiating dialysis.
abstract: Predialysis nephrology care is associated with lower mortality and rates of hospitalization following chronic dialysis initiation. Whether more frequent predialysis nephrology care is associated with other favorable outcomes for older adults is not known.
  
  
  
  Retrospective cohort study of patients ≥66 years who initiated chronic dialysis in 2000-2001 and were eligible for VA and/or Medicare-covered services. Nephrology visits in VA and/or Medicare during the 12-month predialysis period were identified and classified by low intensity (<3 visits), moderate intensity (3-6 visits), and high intensity (>6 visits). Outcome measures included very low estimated glomerular filtration rate, severe anemia, use of peritoneal dialysis, and receipt of permanent vascular access at dialysis initiation and death and kidney transplantation within two years of initiation. Generalized linear models with propensity score weighting were used to examine the association between nephrology care and outcomes.
  
  
  
  Among 58,014 patients, 46 % had none, 22 % had low, 13 % had moderate, and 19 % had high intensity predialysis nephrology care. Patients with a greater intensity of predialysis nephrology care had more favorable outcomes (all p < 0.001). In adjusted models, patients with high intensity predialysis nephrology care were less likely to have severe anemia (RR = 0.70, 99 % CI: 0.65-0.74) and more likely to have permanent vascular access (RR = 3.60, 99 % CI: 3.42-3.79) at dialysis initiation, and less likely to die within two years of dialysis initiation (RR = 0.80, 99 % CI: 0.77-0.82).
  
  
  
  In a large cohort of older adults treated with chronic dialysis, greater intensity of predialysis nephrology care was associated with more favorable outcomes.
authors.affiliation: Medicine/Nephrology, Jesse Brown VA Medical Center, University of Illinois Medical Center, Chicago, IL, USA. fischerm@uic.edu.|Center of Innovation for Complex Chronic Care, Edward Hines, Jr. VA Hospital, Hines, IL, USA. fischerm@uic.edu.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Fischer
authors.affiliation: Center of Innovation for Complex Chronic Care, Edward Hines, Jr. VA Hospital, Hines, IL, USA.|Department of Public Health Sciences, Loyola University Chicago, Maywood, IL, USA.
authors.forename: Kevin T
authors.initials: KT
authors.lastname: Stroupe
authors.affiliation: Medicine/Nephrology, VA New York Harbor Healthcare System, New York, NY, USA.|New York University School of Medicine, New York, NY, USA.
authors.forename: James S
authors.initials: JS
authors.lastname: Kaufman
authors.affiliation: Medicine/Nephrology, VA Puget Sound Healthcare System, Seattle, WA, USA.|Medicine/Nephrology, Group Health Research Institute, University of Washington, Seattle, WA, USA.
authors.forename: Ann M
authors.initials: AM
authors.lastname: O'Hare
authors.affiliation: Center of Innovation for Complex Chronic Care, Edward Hines, Jr. VA Hospital, Hines, IL, USA.|VA Information Resource Center, Edward Hines, Jr. VA Hospital, Hines, IL, USA.
authors.forename: Margaret M
authors.initials: MM
authors.lastname: Browning
authors.affiliation: Center of Innovation for Complex Chronic Care, Edward Hines, Jr. VA Hospital, Hines, IL, USA.|Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA.
authors.forename: Min-Woong
authors.initials: MW
authors.lastname: Sohn
authors.affiliation: Center of Innovation for Complex Chronic Care, Edward Hines, Jr. VA Hospital, Hines, IL, USA.
authors.forename: Zhiping
authors.initials: Z
authors.lastname: Huo
authors.affiliation: Center of Innovation for Complex Chronic Care, Edward Hines, Jr. VA Hospital, Hines, IL, USA.|VA Information Resource Center, Edward Hines, Jr. VA Hospital, Hines, IL, USA.|Medicine/Health Promotion Research, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA.
authors.forename: Denise M
authors.initials: DM
authors.lastname: Hynes
mesh_terms: D000368:Aged; D000740:Anemia / Q000209:etiology; D001166:Arteriovenous Shunt, Surgical / Q000706:statistics & numerical data; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D016030:Kidney Transplantation / Q000706:statistics & numerical data; D008297:Male; D009398:Nephrology / Q000379:methods / Q000706:statistics & numerical data*; D009819:Office Visits / Q000706:statistics & numerical data*; D010530:Peritoneal Dialysis / Q000706:statistics & numerical data; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Dialysis; Elderly; Nephrology care