Observational studyAmerican journal of kidney diseases : the official journal of the National Kidney Foundation2017
Receipt of Nephrology Care and Clinical Outcomes Among Veterans With Advanced CKD.
Observational study in American journal of kidney diseases : the official journal of the National Kidney Foundation, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 25 papers, 1 of them a synthesis that pooled it.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
25 citing papers in PubMed, 1 synthesis or guideline pooled it, 30 citations in OpenAlex.
- Application and implementation of telehealth services designed for the elderly population during the COVID-19 pandemic: A systematic review.Health informatics journalPooled it
- Characteristics of Veterans with CKD Using a Telenephrology Program in the Veterans Health Administration.Clinical journal of the American Society of Nephrology : CJASN · 2026Article
- Profile, follow-up adherence and progression of people with advanced chronic kidney disease in specialized care centers: a retrospective study, Santa Catarina state, Brazil, 2021-2024.Epidemiologia e servicos de saude : revista do Sistema Unico de Saude do Brasil · 2026Article
- Management status of patients with chronic kidney disease across medical specialties in Japan: a real-world data analysis.Scientific reports · 2025Article
- Referral, monitoring, and factors associated with non-referral of chronic kidney disease in Germany: a nationwide, retrospective cohort study.The Lancet regional health. Europe · 2024Article
- Informed Dialysis Modality Selection Among Veterans With Advanced CKD: A Community-Level Needs Assessment.Kidney medicine · 2024Article
- Review
- Electronic Phenotype for Advanced Chronic Kidney Disease in a Veteran Health Care System Clinical Database: Systems-Based Strategy for Model Development and Evaluation.Interactive journal of medical research · 2023Article
- Using RE-AIM to examine implementation of a tele-nephrology program for veterans living in rural areas.Frontiers in health services · 2023Article
- 15-year-change of phenotype and prognosis in non-dialysis CKD patients referred to a nephrology clinic.International urology and nephrology · 2022Observational
- Gaps in Nephrology Referral Care Utilization in Patients at High-Risk of Progression to Kidney Failure.AMIA ... Annual Symposium proceedings. AMIA Symposium · 2022Article
- Renin-angiotensin system blocker discontinuation and adverse outcomes in chronic kidney disease.Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association · 2021Article
- Nephrology consultation and kidney failure in people with stage 4 chronic kidney disease: a population-based cohort study.Journal of nephrology · 2021Article
- Facility-Level Variation in Dialysis Use and Mortality Among Older Veterans With Incident Kidney Failure.JAMA network open · 2021Article
- Rapid Integration of Home Telehealth Visits Amidst COVID-19: What Do Older Adults Need to Succeed?Journal of the American Geriatrics Society · 2020Article
- Primary care referrals to nephrology in patients with advanced kidney disease.The American journal of managed care · 2020Article
- Proteinuria impacts patient survival differentially based on clinical setting: A retrospective cross-sectional analysis of cohorts from a single health system: Retrospective cohort study.Annals of medicine and surgery (2012) · 2019Article
- Trends in Quality of Care for Patients with CKD in the United States.Clinical journal of the American Society of Nephrology : CJASN · 2019Article
- Predialysis Nephrology Care and Incident Atrial Fibrillation in Older Patients With ESKD Initiating Dialysis.Kidney international reports · 2019Article
- Predialysis Care and Cardiovascular Outcomes: Why the Lead Up to Dialysis Matters.Kidney international reports · 2019Article
Corrections and comments
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Authors and funding
6 authors at 3 institutions in 1 country.
Funding
Abstract
backgroundClinical practice guidelines recommend referral to nephrology when estimated glomerular filtration rate (eGFR) decreases to <30mL/min/1.73m STUDY
designObservational cohort using landmark analysis. SETTINGS &
participantsA national cohort of veterans with advanced chronic kidney disease, defined as an outpatient eGFR≤30mL/min/1.73m PREDICTOR: Receipt and frequency of outpatient nephrology care over 12 months. OUTCOMES: Survival and progression to end-stage renal disease (ESRD; receipt of dialysis or kidney transplantation) were the primary outcomes. In addition, control of associated clinical parameters over 12 months were intermediate outcomes.
resultsOf 39,669 patients included in the cohort, 14,983 (37.8%) received nephrology care. Older age, heart failure, dementia, depression, and rapidly declining kidney function were independently associated with the absence of nephrology care. During a mean follow-up of 2.9 years, 14,719 (37.1%) patients died and 4,310 (10.9%) progressed to ESRD. In models adjusting for demographics, comorbid conditions, and trajectory of kidney function, nephrology care was associated with lower risk for death (HR, 0.88; 95% CI, 0.85-0.91), but higher risk for ESRD (HR, 1.48; 95% CI, 1.38-1.58). Among patients with clinical parameters outside guideline recommendations at cohort entry, a significantly higher adjusted proportion of patients who received nephrology care had improvement in control of hemoglobin, potassium, albumin, calcium, and phosphorus concentrations compared with those who did not receive nephrology care. LIMITATIONS: May not be generalizable to nonveterans.
conclusionsAmong patients with advanced chronic kidney disease, nephrology care was associated with lower mortality, but was not associated with lower risk for progression to ESRD.
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Registered trials
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