By writer to www.renalandurologynews.com
Dialysis use for incident kidney failure in older veterans varies broadly amongst Veterans Affairs (VA) services, however the variations don’t correlate with facility-level mortality charges, in accordance with a current research.
The research included 8695 veterans with a imply age of 78.eight years handled at 108 VA services. All had stage three or Four power kidney illness that progressed to kidney failure throughout January 1, 2011 to December 31, 2014. Of the sufferers who began dialysis, 83% began on hemodialysis slightly than peritoneal dialysis.
After adjusting for affected person and facility traits, the research discovered a 1.4-fold variation in dialysis use charges and 1.08-fold variation in mortality charges throughout VA services after adjusting for affected person and facility traits, investigators led by Manjula Kurella Tamura, MD, MPH, of the Stanford College College of Medication and Geriatric Analysis and Schooling Medical Middle on the Veterans Affairs Palo Alto Well being Care System, in Palo Alto, California, reported on-line in JAMA Community Open.
“We discovered sizeable unexplained variation in dialysis use practices amongst older adults throughout VA services that didn’t seem like correlated with how sick the sufferers have been,” they acknowledged.
The noticed frequency of dialysis use throughout the 108 VA services ranged from 25.0% to 81.4%, with a median price of 51.7%, in accordance with the investigators. The noticed mortality price ranged from 27.2% to 60.0%, with a median price of 45.2%.
“The unexplained variation in each outcomes primarily derived from affected person traits slightly than facility traits,” the authors wrote.
The magnitude of between-facility variation in dialysis use was much like the impact sizes for medical traits similar to pre-kidney failure nephrology care, most cancers, and dementia, in accordance with the investigators.
Nephrology care within the 12 months earlier than incident kidney failure was considerably related to a 34% decrease danger of dialysis use inside 2 years. Sufferers who obtain nephrology care “could also be extra compliant with therapy and should have higher entry to wanted therapies and providers, thus lowering their price of illness development,” the authors acknowledged.
Most cancers and dementia diagnoses have been considerably related to a 20% and 40% decreased probability of beginning dialysis, respectively.
Variation in dialysis use amongst sufferers with an estimated glomerular filtration price of 15 mL/min/1.73 m2 accounted for a few of the variation in dialysis use patterns, in accordance with Dr Tamura and colleagues.
Bradshaw C, Thomas IC, Montez-Rath ME, et al. Facility-level variation in dialysis use and mortality among older veterans with incidence kidney failure. Printed on-line January 15, 2021. JAMA Netw Open. doi:10.1001/jamanetworkopen.2020.34084