ArticleBMC nephrology2015
State level variations in nephrology workforce and timing and incidence of dialysis in the United States among children and adults: a retrospective cohort study.
Article in BMC nephrology, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.
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Who cites it
9 citing papers in PubMed.
- Variation in Attitudes to Native Kidney Biopsy Practice in the United States.Kidney medicine · 2026Article
- Pediatric Nephrology Workforce and Access of Children with Kidney Failure to Transplantation in the United States.Journal of the American Society of Nephrology : JASN · 2025Article
- Enhancing primary care capacity in chronic kidney disease management: a quality improvement educational initiative.BMJ open · 2021Article
- Starting Renal Replacement Therapy: Is It About Time?American journal of nephrology · 2019Observational
- Capacity of Kidney Care in Canada: Identifying Barriers and Opportunities.Canadian journal of kidney health and disease · 2019Article
- Use of the Kidney Failure Risk Equation to Determine the Risk of Progression to End-stage Renal Disease in Children With Chronic Kidney Disease.JAMA pediatrics · 2018Observational
- Racial and Ethnic Disparities in Survival of Children with ESRD.Journal of the American Society of Nephrology : JASN · 2017Article
- Timing of Dialysis Initiation: What Has Changed Since IDEAL?Seminars in nephrology · 2017Review
- The global nephrology workforce: emerging threats and potential solutions!Clinical kidney journal · 2016Article
Corrections and comments
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Authors and funding
5 authors.
Funding
Abstract
backgroundMultiple factors influence timing of dialysis initiation. The impact of supply of nephrology workforce on timing and incidence of dialysis initiation is not well known.
methodsWe determined the number of pediatric and adult nephrologists in each state using data from the American Medical Association and American Boards of Internal Medicine and Pediatrics. We ascertained state population data from the 2010 US Census. United States Renal Data System (USRDS) data were used to determine estimated glomerular filtration rate (eGFR) at dialysis initiation and dialysis incidence for adults (≥18 years) in 2008 and children (<18 years) in 2007-2009 by state.
resultsAcross all states, there were a median of 3.0 (IQR 2.3 to 3.4) adult nephrologists per 100,000 adults and 0.5 (IQR 0.2 to 0.9) pediatric nephrologists per 100,000 children. The median eGFR at start of dialysis was 9.8 mL/min/1.73 m2 (IQR 7.1-13.1) in adults and 8.5 mL/min/1.73 m2 (IQR 6.2-11.4) in children. Neither the number of adult (Spearman r of 0.02 [95% CI -0.26-0.30], p = 0.88) nor pediatric (Spearman r of -0.13 [95% -0.39-0.15], p = 0.38) nephrologists per state population was associated with mean eGFR across states. The number of nephrologists per state population was associated with incident dialysis cases per state population in adults (Spearman r of 0.50 [95% CI 0.26-0.68], p = 0.0002), but not in children (Spearman r of -0.06 [95% CI -0.33-0.22], p = 0.67). In linear regression models, the association between nephrologists per state population and incident dialysis cases per state population remained statistically significant (p = 0.006) after adjustment for provider characteristics.
conclusionsNephrology workforce supply is aligned with demand but does not appear to be associated with timing of dialysis initiation.
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