Females, patients with diabetes, whites, non-Hispanics, and older patients were more likely to have received pre-ESRD nephrology care.
Patients starting treatment on hemodialysis with a fistula were also more likely to have received pre-ESRD nephrology care.
Chart Explanation: Predictors of pre-ESRD nephrology care were investigated. Females, patients with diabetes, whites, non-Hispanics, and older patients were more likely to have received pre-ESRD nephrology care. In addition, patients with higher hemoglobin or albumin values, patients with mid-range eGFR values (5-14.9 ml/min/1.73 m²) and patients starting treatment on hemodialysis with a fistula were also more likely to have received pre-ESRD nephrology care.
Within the United States, health insurance for all individuals with end-stage renal disease (ESRD) is covered by the Centers for Medicare and Medicaid Services. These results were taken from analyses using 100% of the national ESRD population data.
Beginning in June 2005, information related to pre-ESRD care was collected on all new ESRD patients via the Medical Evidence Form (CMS-2728). In November 2007, researchers presented “Earlier Pre-ESRD Care Throughout the U.S. is Associated with Better Survival for Dialysis Patients in Their First Year of ESRD” (Saran et al., 2007) at the 2007 annual meeting of the American Society of Nephrology. Utilizing national CMS data and data collected on the form CMS-2728 for 52,277 incident ESRD patients between June 1, 2005 and December 31, 2005 who survived to day 90 of ESRD treatment, timing of pre-ESRD nephrology care, dietitian care and EPO treatment were investigated. A patient was considered under the care of a nephrologist, kidney dietitian, or EPO treated if their form indicated “Yes” in the check box for the corresponding question; if the box “No” was checked, the patient was classified as none; if the box “Unknown” was checked, the patient was classified as unknown. Timing of pre-ESRD care was assigned according to the check box on the form indicating “6-12 months,” “>12 months,” or assigned “<6 months” if the form indicated treatment but the length of treatment box was left unchecked.
|Description of Measure||Pre-ESRD care|
|Data Source||Centers for Medicare and Medicaid Services Medical Evidence Form (CMS-2728)|
|Type of Data Source||Administrative|
|Health Care System Data||No|
|Regional or National?||National|
|Demographic Group||Incident dialysis patients|
|Numerator||All individuals in denominator|
|Denominator||52,277 ESRD patients incident between 6/1/05 and 12/31/05 who survived to day 90 of ESRD treatment|
|Definition of diagnosed CKD||Stage 5 with Medicare-eligibility for ESRD treatment|
|Primary Data Source Indicator||Nephrology care, Dietitian care and Erythropoietin (EPO) treatment immediately prior to ESRD|
|Primary Indicator Method of Measurement||Reported on CMS-2728 form|
|Secondary (1) Variable||Demographics (e.g. age, gender, race/ethnicity), Health (e.g. BMI, diabetes status, dialysis modality), Labs (e.g. serum creatinine, urine albumin, hemoglobin)|
|Secondary (1) Variable Method of Measurement||All as reported on CMS 2728 form|
|Secondary (2) Variable||eGFR|
|Secondary (2) Variable Method of Measurement||Calculated using 4-variable, MDRD-study formula using data from CMS 2728 form|
|Secondary (4) Variable||Mortality|
|Secondary (4) Variable Method of Measurement||Multiple sources: CROWNWeb (Consolidated Renal Operations in a Web-enabled format) Form 2746, Renal Management Information System (REMIS), ESRD Death Notification|
|Frequency of Measurement (Primary)||Once|
|Period Currently Available||2005|
|Additional Data Items of Interest||Tracking of care immediately prior to ESRD registration began in 2005.|
|Limitations of Indicator||Information on pre-ESRD care is self-reported. Some 10-18% of individuals were unsure of their pre-ESRD care level.|
References and Sources:
Gillespie BW, Morgenstern H, Hedgeman E, et al. Nephrology care prior to end-stage renal disease and outcomes among new ESRD patients in the USA. Clin Kidney J. 2015 Dec;8(6):772-80.
Saran R, et al. Earlier pre-ESRD care throughout the United States is associated with better survival for dialysis patients in their first year of ESRD. J Am Soc Nephrol 18: 299A, 2007