title: Frequency of Early Predialysis Nephrology Care and Postdialysis Cardiovascular Events.
abstract: BACKGROUND
  Patients with kidney failure are at a high risk for cardiovascular events. Predialysis nephrology care has been reported to improve postdialysis survival, but its effects on postdialysis major adverse cardiovascular events (MACEs) have not been comprehensively studied.
  
  
  METHODS
  Observational cohort study.
  
  
  METHODS
  We used data from the National Health Insurance Research Database in Taiwan. Adult patients who initiated maintenance dialysis therapy in 1999 to 2010 were enrolled.
  
  
  METHODS
  We created 3 subtypes of predialysis nephrology care based on the time between the first nephrology visit and the initiation of dialysis therapy: early frequent (duration ≥ 6 months; at least 1 nephrology visit every 3 months), early infrequent (duration ≥ 6 months, <1 nephrology visit every 3 months), and late (duration < 6 months).
  
  
  RESULTS
  MACE was defined using the primary diagnosis in hospitalization records of acute myocardial infarction, acute heart failure, acute stroke, or sudden death.
  
  
  METHODS
  We investigated the associations of different subtypes of nephrology care with postdialysis 1-year MACEs.
  
  
  RESULTS
  Among the 60,329 eligible patients, 24,477 (40.6%) had early frequent, 12,763 (21.2%) had early infrequent, and 23,089 (38.3%) had late nephrology care. Compared to the late-nephrology-care group, the early-frequent group was associated with an ∼10% lower risk for 1-year MACEs (HR of 0.89 [95% CI, 0.82-0.96] for first MACE and relative risk of 0.91 [95% CI, 0.84-0.98] for recurrent MACEs). However, the early-infrequent-care group had similar risks for MACEs as the late group (HR of 0.95 [95% CI, 0.86-1.05] for first MACE and relative risk of 0.94 [95% CI, 0.86-1.02] for recurrent MACEs).
  
  
  CONCLUSIONS
  Lack of physical and biochemical information because of inherent limitations from administrative claims data.
  
  
  CONCLUSIONS
  Early frequent nephrology care for 6 or more months before the initiation of long-term dialysis therapy may improve 1-year postdialysis major cardiovascular outcomes.
authors.affiliation: Division of Nephrology, Far Eastern Memorial Hospital, New Taipei City, Taiwan; Department of Quality Management Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
authors.forename: Ju-Yeh
authors.initials: JY
authors.lastname: Yang
authors.affiliation: Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Jenq-Wen
authors.initials: JW
authors.lastname: Huang
authors.affiliation: Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan.
authors.forename: Likwang
authors.initials: L
authors.lastname: Chen
authors.affiliation: Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan.
authors.forename: Yun-Yi
authors.initials: YY
authors.lastname: Chen
authors.affiliation: Division of Nephrology, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
authors.forename: Mei-Fen
authors.initials: MF
authors.lastname: Pai
authors.affiliation: Division of Nephrology, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
authors.forename: Kuei-Ting
authors.initials: KT
authors.lastname: Tung
authors.affiliation: Division of Nephrology, Far Eastern Memorial Hospital, New Taipei City, Taiwan. Electronic address: taan70@yahoo.com.tw.
authors.forename: Yu-Sen
authors.initials: YS
authors.lastname: Peng
authors.affiliation: Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Kuan-Yu
authors.initials: KY
authors.lastname: Hung
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D015331:Cohort Studies; D061345:Early Medical Intervention; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012307:Risk Factors
keywords: Predialysis nephrology care; cardiovascular events; chronic kidney disease (CKD); dialysis; dialysis access; dialysis initiation; end-stage renal disease (ESRD); major adverse cardiac event (MACE); quality of care; survival; transition of care