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Wahood W, Takahashi E, Rajan D, Misra S. National Trends in Complications of Vascular Access for Hemodialysis and Analysis of Racial Disparities Among Patients With End-Stage Renal Disease in the Inpatient Setting. Kidney Int Rep 2023; 8:1162-1169. [PMID: 37284686 PMCID: PMC10239770 DOI: 10.1016/j.ekir.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 01/31/2023] [Accepted: 03/06/2023] [Indexed: 04/04/2023] Open
Abstract
Introduction The aim of this study is to assess the trends in access-related complications, as well as the impact of race on these complications, among admitted patients with end-stage kidney disease (ESKD) receiving hemodialysis. Methods A retrospective cohort study between 2005 and 2018 was performed using the National Inpatient Sample (NIS). Hospitalizations involving ESKD and hemodialysis were identified. There were 9,246,553 total admissions involving ESKD and hemodialysis, of which 1,167,886 (12.6%) had complications. Trends in complications were assessed and compared among races. Results There was a decreasing trend in rates of mechanical (trend: -0.05% per year; P < 0.001), inflammatory or infectious (-0.48%; P < 0.001), and other (-0.19%; P < 0.001) complications from 2005 to 2018. Non-White patients had a greater magnitude in the decrease in trends in rates of complications compared to White patients (-0.69% per year vs. -0.57%; P < 0.001). Compared to the White patients, Black patients (odds ratio [OR]: 1.26; P < 0.001) and those of the other races (OR: 1.11; P < 0.001) had higher odds of complications. These differences were also statistically significant among lower socioeconomic classes (75 percentile vs. 0-25 percentile: P = 0.009) and within southern states (vs. Northeast: P < 0.001). Conclusion Although there was an overall decrease in the trends of dialysis-associated complications requiring hospitalization among ESKD patients receiving hemodialysis, non-White patients have higher odds of complications compared to White patients. The findings in this study emphasize the need for more equitable care for hemodialysis patients.
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Affiliation(s)
- Waseem Wahood
- Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Davie, Florida, USA
| | - Edwin Takahashi
- Department of Interventional Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Dheeraj Rajan
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Sanjay Misra
- Department of Interventional Radiology, Mayo Clinic, Rochester, Minnesota, USA
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Schemenaur M, Norris C, Timmons E, Jacob A. Estimating the effect of New Jersey's 2005 administrative nurse mandate on mortality and hospitalizations for medicare hemodialysis patients. Semin Dial 2021; 33:410-417. [PMID: 33448474 DOI: 10.1111/sdi.12905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVES In 2005, the New Jersey Department of Health enacted a rule requiring that an administrator or designate always be present in a hemodialysis clinic and that the individual may not be involved in patient care activities at any time. Our investigation examines the effect of this unique rule on patient mortality and hospitalizations and is meant to inform the public policy discussion. DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS We utilized a synthetic control estimation to analyze the effect of this rule on patient mortality in New Jersey. We also compared trends for hospitalizations in New Jersey to other similar states. RESULTS We find no evidence that the law affected patient mortality or the number of hospitalizations for Medicare patients in New Jersey. CONCLUSIONS The New Jersey law poses substantial costs to hemodialysis clinics and we find little evidence of any measurable benefit to patients.
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Affiliation(s)
| | | | | | - Allan Jacob
- Physicians Dialysis, Miami Beach, Florida, USA
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Anumudu SJ, Erickson KF. Physician reimbursement for outpatient dialysis care: Past, present, and future. Semin Dial 2020; 33:68-74. [DOI: 10.1111/sdi.12853] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 12/20/2019] [Indexed: 11/30/2022]
Affiliation(s)
| | - Kevin F. Erickson
- Section of Nephrology Baylor College of Medicine Houston Texas
- Baylor College of Medicine Center for Innovations in Quality, Effectiveness, and Safety Houston Texas
- Baker Institute for Public Policy Rice University Houston Texas
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Anumudu SJ, Eknoyan G. A historical perspective of how public policy shaped dialysis care delivery in the United States. Semin Dial 2020; 33:5-9. [DOI: 10.1111/sdi.12856] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Samaya J. Anumudu
- Section of Nephrology Selzman Institute of Kidney Health Department of Medicine Baylor College of Medicine Houston TX USA
| | - Garabed Eknoyan
- Section of Nephrology Selzman Institute of Kidney Health Department of Medicine Baylor College of Medicine Houston TX USA
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Maddux FW. The authority of courage and compassion: Healthcare policy leadership in addressing the kidney disease public health epidemic. Semin Dial 2020; 33:35-42. [PMID: 31919887 PMCID: PMC7004129 DOI: 10.1111/sdi.12849] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Recent developments in US kidney‐related healthcare policy have made chronic kidney disease (CKD) a societal focus in the United States. In the biggest policy change since the 1972 Social Security Amendments that extended Medicare coverage to patients with kidney failure regardless of age, a 2019 presidential executive order pledged to reduce end‐stage kidney disease, slow CKD progression, increase kidney transplants, and focus on home dialysis care. This manuscript seeks to outline key factors that can enable this milestone moment to evolve a policy framework that improves the health of society while being economically sustainable. Understanding the sociohistorical context of healthcare policy and the related lessons learned demonstrates that policy must take a broader view of the societal and system wide factors that affect chronic illness. Addressing the full breadth of the CKD epidemic requires looking at factors from both inside and outside traditional medical‐pathophysiological environments, including social determinants of health. This more fulsome insight will enable policy to better align the broad range of people and organizations who are working to combat the disease. By creating patient‐centered policy that both evolves with the speed of innovation and addresses root causes of CKD instead of narrowly focusing on symptoms or comorbidities alone, leaders in the public square have an historic opportunity to thoughtfully create the common ground of a lasting policy legacy that improves society's health today and for generations to come.
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Norris KC, Duru OK, Alicic RZ, Daratha KB, Nicholas SB, McPherson SM, Bell DS, Shen JI, Jones CR, Moin T, Waterman AD, Neumiller JJ, Vargas RB, Bui AAT, Mangione CM, Tuttle KR. Rationale and design of a multicenter Chronic Kidney Disease (CKD) and at-risk for CKD electronic health records-based registry: CURE-CKD. BMC Nephrol 2019; 20:416. [PMID: 31747918 PMCID: PMC6868861 DOI: 10.1186/s12882-019-1558-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 09/12/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is a global public health problem, exhibiting sharp increases in incidence, prevalence, and attributable morbidity and mortality. There is a critical need to better understand the demographics, clinical characteristics, and key risk factors for CKD; and to develop platforms for testing novel interventions to improve modifiable risk factors, particularly for the CKD patients with a rapid decline in kidney function. METHODS We describe a novel collaboration between two large healthcare systems (Providence St. Joseph Health and University of California, Los Angeles Health) supported by leadership from both institutions, which was created to develop harmonized cohorts of patients with CKD or those at increased risk for CKD (hypertension/HTN, diabetes/DM, pre-diabetes) from electronic health record data. RESULTS The combined repository of candidate records included more than 3.3 million patients with at least a single qualifying measure for CKD and/or at-risk for CKD. The CURE-CKD registry includes over 2.6 million patients with and/or at-risk for CKD identified by stricter guide-line based criteria using a combination of administrative encounter codes, physical examinations, laboratory values and medication use. Notably, data based on race/ethnicity and geography in part, will enable robust analyses to study traditionally disadvantaged or marginalized patients not typically included in clinical trials. DISCUSSION CURE-CKD project is a unique multidisciplinary collaboration between nephrologists, endocrinologists, primary care physicians with health services research skills, health economists, and those with expertise in statistics, bio-informatics and machine learning. The CURE-CKD registry uses curated observations from real-world settings across two large healthcare systems and has great potential to provide important contributions for healthcare and for improving clinical outcomes in patients with and at-risk for CKD.
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Affiliation(s)
- Keith C Norris
- David Geffen School of Medicine at University of California, Los Angeles, CA, 90095, USA.
- UCLA Department of Medicine, Division of General Internal Medicine, 1100 Glendon Ave. Suite 900, Los Angeles, CA, 90024, USA.
| | - O Kenrik Duru
- David Geffen School of Medicine at University of California, Los Angeles, CA, 90095, USA
| | - Radica Z Alicic
- Providence St. Joseph Health, Providence Medical Research Center, Spokane, Washington, USA
- University of Washington School of Medicine, Seattle, Washington, USA
| | - Kenn B Daratha
- Providence St. Joseph Health, Providence Medical Research Center, Spokane, Washington, USA
| | - Susanne B Nicholas
- David Geffen School of Medicine at University of California, Los Angeles, CA, 90095, USA
| | - Sterling M McPherson
- Providence St. Joseph Health, Providence Medical Research Center, Spokane, Washington, USA
- Washington State University Elson S. Floyd College of Medicine, Spokane, Washington, USA
| | - Douglas S Bell
- David Geffen School of Medicine at University of California, Los Angeles, CA, 90095, USA
| | - Jenny I Shen
- David Geffen School of Medicine at University of California, Los Angeles, CA, 90095, USA
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Cami R Jones
- Providence St. Joseph Health, Providence Medical Research Center, Spokane, Washington, USA
| | - Tannaz Moin
- David Geffen School of Medicine at University of California, Los Angeles, CA, 90095, USA
- VA Greater Los Angeles, Los Angeles, USA
| | - Amy D Waterman
- David Geffen School of Medicine at University of California, Los Angeles, CA, 90095, USA
| | - Joshua J Neumiller
- Washington State University College of Pharmacy and Pharmaceutical Sciences, Spokane, USA
| | - Roberto B Vargas
- Charles R. Drew University of Medicine and Science, Los Angeles, USA
- RAND Corporation, Santa Monica, CA, USA
| | - Alex A T Bui
- David Geffen School of Medicine at University of California, Los Angeles, CA, 90095, USA
| | - Carol M Mangione
- David Geffen School of Medicine at University of California, Los Angeles, CA, 90095, USA
| | - Katherine R Tuttle
- Providence St. Joseph Health, Providence Medical Research Center, Spokane, Washington, USA
- University of Washington School of Medicine, Seattle, Washington, USA
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