2011 Top Game Changers in Nephrology

George Bakris, MD; Jeffrey S. Berns, MD; Lynda A. Szczech, MD; Carol Peckham


November 16, 2011

In This Article

9. Early Nephrology Care Useless? A Worrisome Conclusion

A paper published in 2011 in the Archives of Internal Medicine by Winkelmayer and colleagues[3] examined the impact of predialysis care on first-year mortality among patients who started dialysis between the years 1996 and 2007. Data were accumulated primarily from the United States Renal Data System and were then backtracked for 2 years using Medicare claims data. In his Medscape commentary, Jeffrey Berns noted, "The final conclusion of the article remains to be fully explored, but it suggested that predialysis care did not show any improvements. In fact, the study showed a 36% reduction in 1-year mortality associated with earlier nephrology care [that occurred] 90 days or more before the start of dialysis. This patient cohort was elderly, with a mean age of around 75 years and an extensive list of comorbidities. Two thirds of the patients had diabetes mellitus, almost all had hypertension, 70% had heart failure, and 18% to 45% of patients had coronary artery disease, cerebrovascular disease, peripheral arterial disease, chronic obstructive pulmonary disease, and cancer This is a patient population with an extraordinarily high mortality and an extraordinarily high burden of cardiovascular disease. Therefore, it is not at all surprising to me that predialysis care would not necessarily have had a huge impact. Again, I am very concerned that the conclusions of this article will be applied to a very different patient population, and because of the limitations of this analysis, I am not convinced that we should conclude from this paper, even in the population studied, that predialysis care is of no value."

Watch the complete commentary from Jeffrey Berns, MD.


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