Predialysis Nephrology Care Advantages Older Veterans

by U.S. Medicine

November 13, 2016

CHICAGO—Predialysis nephrology care is associated with lower mortality and rates of hospitalization following chronic dialysis initiation.

A study published in the journal BMC Nephrology sought to determine, however, whether more frequent predialysis nephrology care is associated with other favorable outcomes for older adults.1

Previous research has demonstrated that absent, infrequent or late nephrology care prior to dialysis initiation for patients with end-stage kidney disease (ESKD) is associated with significantly higher subsequent mortality and prolonged hospitalizations Yet, according to background information in the report, few of the studies included older patients, despite their high burden of ESKD treated with chronic dialysis. Compared with adults under the age of 60, incidence rates of treated ESKD are more than twofold higher in those 65-69 years old and threefold higher in those 80-84 years old, the article added.

A study team led by researchers from the Jesse Brown VAMC and the Center of Innovation for Complex Chronic Care at the Edward Hines Jr. VA Hospital looked at a retrospective cohort study of patients 66 and older who initiated chronic dialysis in 2000-2001.

Participants all were eligible for VA and/or Medicare-covered services and received predialysis care during a 12-month period. Researchers classified the visits as:

  • Low intensity (fewer than 3 visits),
  • Moderate intensity (3-6 visits), and
  • High intensity (more than 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.

Results indicate that, among 58,014 patients, 46% had none, 22% had low, 13% had moderate, and 19% had high intensity predialysis nephrology care.

Study authors reported that patients with a greater intensity of predialysis nephrology care had more favorable. In adjusted models, patients with high intensity predialysis nephrology care were less likely to have severe anemia, with a relative risk (RR) of 0.70, 99%.

They also were more likely to have permanent vascular access, RR of  3.60, at dialysis initiation, and less likely to die within two years of dialysis initiation, RR 0.80.

“In a large cohort of older adults treated with chronic dialysis, greater intensity of predialysis nephrology care was associated with more favorable outcomes,” the researchers concluded.

  1. Fischer MJ, Stroupe KT, Kaufman JS, O’Hare AM, Browning MM, Sohn MW, Huo Z, Hynes DM. Predialysis nephrology care and dialysis-related health outcomes among older adults initiating dialysis. BMC Nephrol. 2016 Jul 29;17(1):103. doi:10.1186/s12882-016-0324-5. PubMed PMID: 27473684; PubMed Central PMCID:PMC4966864.


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