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Impact of specialization of primary nephrologist on the care of pediatric hemodialysis patients.
- Source :
-
American journal of kidney diseases : the official journal of the National Kidney Foundation [Am J Kidney Dis] 2006 Jan; Vol. 47 (1), pp. 115-21. - Publication Year :
- 2006
-
Abstract
- Background: Children with end-stage renal disease (ESRD) receiving hemodialysis may have their care overseen primarily by a pediatric nephrologist or internal medicine (IM) nephrologist.<br />Methods: To examine specific clinical outcomes by nephrologist specialization, a cross-sectional analysis of demographic and clinical data collected in the 2002 ESRD Clinical Performance Measures Project was performed.<br />Results: Of 653 pediatric patients meeting inclusion criteria, 27% were cared for by IM nephrologists, and 73%, by pediatric nephrologists. Pediatric nephrologists were significantly more likely than IM nephrologists to care for patients who were younger and of Hispanic ethnicity. Patients of pediatric compared with IM nephrologists also were more likely to have a congenital cause of ESRD, smaller body mass index, and longer time on dialysis therapy. No significant differences in achieving a mean Kt/V of 1.2 or greater or mean hemoglobin level of 11 g/dL or greater (> or =110 g/L) according to nephrologist specialization were observed. After adjustment for patient clinical characteristics, no significant difference in use of arteriovenous fistulae was observed. Patients cared for by pediatric nephrologists were less likely to achieve a mean serum albumin level of 4.0/3.7 g/dL (40/37 g/L; bromcresol green laboratory method/bromcresol purple laboratory method; adjusted odds ratio, 0.60; 95% confidence interval, 0.42 to 0.86). Patients cared for by pediatric nephrologists had significantly greater serum calcium levels, lower serum phosphate levels, and lower intact parathyroid hormone levels.<br />Conclusion: Using adult-focused clinical care targets, care provided by pediatric and IM nephrologists to pediatric patients receiving hemodialysis in the United States is similar. However, differences exist, and the significance of these differences requires further study.
- Subjects :
- Adolescent
Albuminuria epidemiology
Albuminuria etiology
Anemia epidemiology
Anemia etiology
Anemia therapy
Arteriovenous Shunt, Surgical statistics & numerical data
Catheters, Indwelling statistics & numerical data
Child
Child, Preschool
Cross-Sectional Studies
Ethnicity statistics & numerical data
Female
Humans
Hypercalcemia epidemiology
Hypercalcemia etiology
Infant
Kidney Diseases congenital
Kidney Diseases epidemiology
Kidney Failure, Chronic blood
Kidney Failure, Chronic epidemiology
Kidney Failure, Chronic etiology
Kidney Function Tests
Male
Metabolic Clearance Rate
Phosphorus blood
Surveys and Questionnaires
Treatment Outcome
United States epidemiology
Internal Medicine
Kidney Failure, Chronic therapy
Nephrology
Pediatrics
Renal Dialysis
Subjects
Details
- Language :
- English
- ISSN :
- 1523-6838
- Volume :
- 47
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- American journal of kidney diseases : the official journal of the National Kidney Foundation
- Publication Type :
- Academic Journal
- Accession number :
- 16377392
- Full Text :
- https://doi.org/10.1053/j.ajkd.2005.10.005