Back to Search
Start Over
Nephrologist Follow-Up Care of Patients With Acute Kidney Disease Improves Outcomes: Taiwan Experience.
- Source :
-
Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research [Value Health] 2020 Sep; Vol. 23 (9), pp. 1225-1234. Date of Electronic Publication: 2020 Aug 06. - Publication Year :
- 2020
-
Abstract
- Objectives: Acute kidney injury (AKI) and acute kidney disease (AKD) are a continuum on a disease spectrum and frequently progress to chronic kidney disease. Benefits of nephrologist subspecialty care during the AKD period after AKI are uncertain.<br />Methods: Patients with AKI requiring dialysis who subsequently became dialysis independent and survived for at least 90 days, defined as the AKD period, were identified from the Taiwanese population's health insurance database. Cox proportional hazard models using death as the competing risk before and after propensity-score matching were applied to evaluate various endpoints.<br />Results: Among a total of 20 260 patients with AKI requiring dialysis who became dialysis independent, only 7550 (37.3%) patients were followed up with by a nephrologist (F/U <subscript>nephrol</subscript> group) during the AKD period. During a mean 4.04 ± 3.56 years of follow-up, the patients in the F/U <subscript>nephrol</subscript> group were more often administered statin, antihypertensives, angiotensin converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB), diuretics, antiplatelet agents, and antidiabetic agents. The patients in the F/U <subscript>nephrol</subscript> group had a lower mortality rate (hazard ratio [HR] = 0.87, P < .001) and were less likely to have major adverse cardiovascular events (MACE) (subdistribution HR [sHR] = 0.85, P < .001), congestive heart failure (CHF) (sHR = 0.81, P < .001), and severe sepsis (sHR = 0.88, P = .008) according to the Cox proportional model after adjusting for mortality as a competing risk. During the AKD period, an increase in the frequency of nephrology visits was associated with improved outcomes.<br />Conclusions: In this population-based cohort, even after weaning off acute dialysis, only a minority of patients visited a nephrologist during the AKD period. We showed that nephrology follow-up is associated with a decrease in MACE, CHF exacerbations, and sepsis, as well as lower mortality; thus it may improve outcomes in patients with AKD.<br /> (Copyright © 2020 ISPOR–The Professional Society for Health Economics and Outcomes Research. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Acute Kidney Injury complications
Acute Kidney Injury mortality
Aged
Aged, 80 and over
Case-Control Studies
Disease Progression
Female
Humans
Male
Middle Aged
Proportional Hazards Models
Taiwan epidemiology
Acute Kidney Injury therapy
Nephrology statistics & numerical data
Renal Dialysis statistics & numerical data
Subjects
Details
- Language :
- English
- ISSN :
- 1524-4733
- Volume :
- 23
- Issue :
- 9
- Database :
- MEDLINE
- Journal :
- Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research
- Publication Type :
- Academic Journal
- Accession number :
- 32940241
- Full Text :
- https://doi.org/10.1016/j.jval.2020.01.024