Late nephrologist referral and access to renal transplantation.
Late nephrologist referral and access to renal transplantation.
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晚期肾病专家转诊并获得肾移植。
DOI：
10.1097/00007890-200206270-00012
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发表时间：
2002
期刊：
影响因子：
6.2
通讯作者：
Avorn,Jerry
中科院分区：
文献类型：
--
作者：
Winkelmayer,WolfgangC;Glynn,RobertJ;Levin,Raisa;Mittleman,MurrayA;Pliskin,JosephS;Avorn,Jerry
背景：我们的目的是探索肾脏替代治疗(RRT)开始前的晚期肾病医师转诊与接受肾移植的可能性之间的可能联系。方法：从1991年到1996年年中，我们确定了所有新发慢性RRT患者的初始队列，这些患者在RRT前一年是新泽西州的联邦医疗保险和/或医疗补助受益人，并且在RRT前一年已经被诊断出患有肾脏疾病。为了控制获得肾移植的已知危险因素和混杂因素，我们进行了配对的病例对照研究。以从RRT开始到移植的天数作为病例的索引日期，我们成功地将32例移植受者与197名对照组进行了配对，这些患者的年龄(±2岁)、性别、种族(白人/黑人/其他)和RRT开始的年份(±1年)相同，但在索引日期没有接受过移植。结果：在全多变量条件模型中，延迟转诊与肾移植的发生率显著相关(优势比[OR]=0.2 2；95%可信区间[CI]：0.0 5，0.97)，以及社会经济状况(OR=0.18；≤=0.2 2；95%可信区间[CI]：0.0 5，0.97)。95%可信区间：0.04，0.82)和合并症状态(OR=0.69；95%可信区间：0.48，1.00)。结论：肾移植患者在RRT前延迟转诊到肾病专科医生那里与肾移植机会减少显著相关，与年龄、性别、种族、社会经济和合并症状况无关。我们的结果的有效性需要在更大的人群中得到证实。
Background.Our aim was to explore a possible association between late nephrologist referral before onset of renal replacement therapy (RRT) and the likelihood of receiving a renal transplant.Methods.For the period of 1991 to mid-1996 we defined an inception cohort of all patients with new-onset chronic RRT who were New Jersey Medicare and/or Medicaid beneficiaries in the year before RRT and who had been diagnosed with renal disease more than 1 year before RRT. To control for known risk factors and confounders of access to renal transplantation, we conducted a matched case-control study. Using number of days from onset of RRT to transplantation as the index date for cases, we successfully matched 32 transplant recipients (cases) with 197 controls who shared the cases’ age (±2 years), gender, race (white/black/other), and year of onset of RRT (±1 year) but had not received a transplant on index date. Using conditional logistic regression, we evaluated the effects on the likelihood of transplantation of late referral (≤ 90 days vs.> 90 days before first RRT) and socioeconomic status (lower socioeconomic status indicated by enrollment in Medicaid or another state program for the poor), further controlling for comorbidity (Charlson score) in the year before index date.Results.In the full multivariate conditional model, late referral was significantly associated with a much lower rate of renal transplantation (odds ratio [OR]= 0.22; 95% confidence interval [CI]: 0.05, 0.97), as were socioeconomic status (OR= 0.18; 95% CI: 0.04, 0.82) and comorbidity status (OR= 0.69; 95% CI: 0.48, 1.00).Conclusions.Delayed referral of renal patients to a nephrologist before RRT is significantly associated with reduced access to renal transplantation, independent of age, gender, race, socioeconomic and comorbidity status. The validity of our result needs to be confirmed in larger populations.