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Survival Benefit of Nephrologic Care in Patients With Diabetes Mellitus and Chronic Kidney Disease

2008; American Medical Association; Volume: 168; Issue: 1 Linguagem: Inglês

10.1001/archinternmed.2007.9

1538-3679

Chin‐Lin Tseng,

Chronic Disease Management Strategies

Background:The association of nephrologic care and survival in patients with diabetes mellitus and chronic kidney disease is unknown.Methods: Using data from 1997 to 2000, we conducted a retrospective cohort study of Veterans Health Administration clinic users having diabetes mellitus and stage 3 or 4 chronic kidney disease.The baseline period was 12 months and median follow-up was 19.3 months.Degree of consistency of visits to a nephrologist, defined as the number of calendar quarters in which there was 1 visit or more (range, 0-4 quarters), and covariates were calculated from the baseline period.The outcome measure was dialysis-free death.Results: Of 39 031 patients, 70.0%, 22.4%, and 7.6% had early stage 3, late stage 3, and stage 4 chronic kidney disease, respectively, and 3.1%, 9.5%, and 28.2%, respectively, visited a nephrologist.Dialysis-free mortality rates were 9.6, 14.1, and 19.4,respectively, per 100 person-years.More calendar quarters with visits to a nephrologist were associated with lower mortality: adjusted hazard ratios were 0.80 (95% confidence interval, 0.67-0.97),0.68 (95% confidence interval, 0.55-0.86),and 0.45 (95% confidence interval, 0.32-0.63),respectively, when the groups having 2, 3, and 4 visits were compared with those who had no visits.One visit only was not associated with a difference in mortality when compared with no visits (adjusted hazard ratio,1.02;95% confidence interval, 0.89-1.16). Conclusions:The consistency of outpatient nephrologic care was independently associated in a graded fashion with lower risk of deaths in patients with diabetes and moderately severe to severe chronic kidney disease.However, only a minority of patients had any visits to a nephrologist.