In determining whether a patient with chronic kidney disease (CKD) receives optimal care before developing kidney failure, geographic area and race play important roles.
This is according to a study appearing in an upcoming issue of the Clinical Journal of the American Society of Nephrology (CJASN). The findings suggest that policies aimed at eliminating disparities in kidney care must take these factors into account.
Timely receipt of care from a kidney specialist over the course of CKD is crucial for slowing the disease, improving survival while on long-term dialysis, and increasing the likelihood of receiving a kidney transplant. And while clinical guidelines recommend that all patients in later stages of CKD be under the care of kidney specialists, 25% to 50% of patients on dialysis in the United States had not received such care before they developed kidney failure, or end-stage renal disease (ESRD). Also, black patients with CKD are less likely to receive optimal kidney care and are more likely to develop ESRD than white patients.
Among the major findings:
- Fewer patients received kidney specialist care for more than 12 months before developing ESRD in large-metro (25.7%) and rural (26.9%) counties than in medium/small-metro counties (31.6%).
- In all four geographic areas, black patients received less pre-ESRD care than their white counterparts. In large-metro counties, black patients were 27% less likely than whites to receive kidney specialist care for more than 12 months before developing ESRD. In rural counties, they were 16% less likely. In suburban and rural counties, black patients were 30% to 52% less likely than whites to see a dietitian before developing ESRD.
"These significant geographic differences in receiving pre-ESRD care and the substantially large racial differences in certain geographic areas highlight the complexity of the issue, and may explain in part the limited progress in improving racial disparities in kidney disease care and outcomes," said Dr. Yan. "Our findings suggest improving receipt of key pre-ESRD care will require more refined regional characterization of health care needs," she added.
In an accompanying editorial, Kevin Abbott, MD, Robert Nee, MD, and Christina Yuan, MD (Walter Reed National Military Medical Center) stated that Dr. Yan and colleagues'' key finding "is that healthcare policies directed at eliminating pre-ESRD care disparities will not necessarily make 'the crooked way straight.'' The way forward is likely to be anything but 'straightforward''-but there are potential investigative and intervention tools available." For example, they pointed to the use of geospatial analysis to quantify current and future healthcare needs in high risk regions and to identify mismatches between needs and available resources. Also, telemedicine could potentially improve access to quality care to otherwise isolated communities, either rural or urban, they wrote.
Study co-authors include Alfred Cheung, MD, Tom Greene, PhD (University of Utah); Keith Norris, MD (Charles R. Drew University of Medicine and Science); Alison Yu (University of Southern California); Jennie Ma, PhD, M. Norman Oliver, MD, and Wei Yu (University of Virginia School of Medicine).
Disclosures: The authors reported no financial disclosures. This work is funded by NIH/NIDDK 5R01DK084200-02. In addition, Dr. Keith Norris is supported in part by NIH grants U54MD007598, UL1TR000124, P30AG021684, and P20-MD000182.
The article, entitled "The Associations between Race and Geographic Area and Quality-of-Care Indicators in Patients Approaching ESRD," will appear online at cjasn.asnjournals.org on March 14, 2013.
The editorial, entitled "Making the Crooked Way Straight: Interpreting Geography and Healthcare Delivery in Chronic Kidney Disease," will appear online at cjasn.asnjournals.org on March 14, 2013.
The content of this article does not reflect the views or opinions of The American Society of Nephrology (ASN). Responsibility for the information and views expressed therein lies entirely with the author(s). ASN does not offer medical advice. All content in ASN publications is for informational purposes only, and is not intended to cover all possible uses, directions, precautions, drug interactions, or adverse effects. This content should not be used during a medical emergency or for the diagnosis or treatment of any medical condition. Please consult your doctor or other qualified health care provider if you have any questions about a medical condition, or before taking any drug, changing your diet or commencing or discontinuing any course of treatment. Do not ignore or delay obtaining professional medical advice because of information accessed through ASN. Call 911 or your doctor for all medical emergencies.
Founded in 1966, and with more than 13,500 members, the American Society of Nephrology (ASN) leads the fight against kidney disease by educating health professionals, sharing new knowledge, advancing research, and advocating the highest quality care for patients.