Background
Methods
Study population and data sources
Study variables
Attributed cause of ESRD
Quality-of-care measures
Other variables
Statistical analysis
Results
Characteristics of the study population by attributed ESRD cause
Characteristic
|
Overall
|
Attributed cause of ESRD*
| ||
---|---|---|---|---|
LN
|
Other GN
|
All other
| ||
N
|
675,889
|
6,594
|
51,537
|
617,758
|
Sociodemographic
| ||||
Age, years, mean (SD) | 62.5 (16.0) | 39.6 (15.4) | 53.9 (18.9) | 63.4 (15.3) |
Sex, % | ||||
Female | 43.7% | 81.1% | 40.7% | 43.5% |
Male | 56.3% | 18.9% | 59.3% | 56.5% |
Race/ethnicity, % | ||||
White | 52.9% | 24.7% | 57.8% | 52.7% |
Black | 28.1% | 49.7% | 22.5% | 28.3% |
Hispanic | 13.4% | 17.7% | 12.3% | 13.4% |
Other | 5.7% | 7.9% | 7.4% | 5.6% |
Insurance at ESRD start, % | ||||
Private | 31.3% | 37.4% | 41.8% | 30.3% |
Medicaid | 24.5% | 32.8% | 18.6% | 24.9% |
Medicare/other | 36.8% | 18.4% | 30.0% | 37.5% |
None | 7.5% | 11.5% | 9.6% | 7.3% |
Clinical
| ||||
Smoking, % | ||||
No | 93.8% | 95.7% | 92.7% | 93.9% |
Yes | 6.2% | 4.3% | 7.3% | 6.1% |
BMI, kg/m2, mean (SD) | 28.9 (7.8) | 26.9 (7.4) | 28.1 (7.5) | 29.0 (7.8) |
Hypertension, % | ||||
No | 15.4% | 16.4% | 17.0% | 15.3% |
Yes | 84.6% | 83.6% | 83.0% | 84.7% |
CVD, % | ||||
No | 57.8% | 81.4% | 75.8% | 56.0% |
Yes | 42.2% | 18.6% | 24.2% | 44.0% |
Albumin, g/dl, mean (SD) | 3.1 (0.7) | 2.9 (0.8) | 3.2 (0.8) | 3.1 (0.7) |
Hemoglobin, g/dl, mean (SD) | 10.0 (1.7) | 9.5 (1.7) | 10.0 (1.8) | 10.0 (1.6) |
Recovery of renal function, % | ||||
No | 95.5% | 93.1% | 95.9% | 95.5% |
Yes | 4.5% | 6.9% | 4.1% | 4.5% |
Association of attributed cause of ESRD with quality-of-care measures
Pre-ESRD care
Quality-of-care measure*
|
Entire follow-up (7/05–9/11)
|
Incident year
|
P
trend
| ||||||
---|---|---|---|---|---|---|---|---|---|
2005
|
2006
|
2007
|
2008
|
2009
|
2010
|
2011
| |||
Pre-ESRD nephrology care, %
| |||||||||
All ESRD (n = 594,556) | 65.7% | 65.9% | 65.6% | 65.0% | 65.0% | 65.5% | 65.9% | 67.7% |
<0.001
|
ESRD attributed to: | |||||||||
Lupus nephritis (n = 5,939) | 71.1% | 72.2% | 70.2% | 71.7% | 70.3% | 73.1% | 68.9% | 72.3% |
0.96
|
Other glomerulonephritis (n = 48,031) | 69.3% | 69.3% | 69.1% | 67.7% | 69.2% | 69.0% | 70.4% | 71.2% |
0.002
|
All other causes (n = 540,586) | 65.3% | 65.5% | 65.2% | 64.6% | 64.6% | 65.1% | 65.5% | 67.4% |
<0.001
|
Informed of transplant options, %
| |||||||||
All ESRD (n = 392,513) | 78.9% | 76.9% | 76.2% | 76.6% | 78.0% | 80.5% | 81.4% | 82.4% |
<0.001
|
ESRD attributed to: | |||||||||
Lupus nephritis (n = 5,619) | 84.8% | 87.0% | 82.6% | 82.6% | 84.8% | 85.9% | 86.5% | 85.8% |
0.07
|
Other glomerulonephritis (n = 32,325) | 83.6% | 82.3% | 82.1% | 81.6% | 83.6% | 84.5% | 85.1% | 87.0% |
<0.001
|
All other causes (n = 354,569) | 78.3% | 76.1% | 75.5% | 76.0% | 77.4% | 80.1% | 81.1% | 82.0% |
<0.001
|
Placement on the kidney transplant waitlist, events/1000 p-y
| |||||||||
All ESRD (n = 392,513) | 97 | 83 | 88 | 91 | 99 | 114 | 122 | 95 |
<0.001
|
ESRD attributed to: | |||||||||
Lupus nephritis (n = 5,619) | 206 | 194 | 177 | 208 | 210 | 230 | 263 | 180 |
0.07
|
Other glomerulonephritis (n = 32,325) | 203 | 162 | 181 | 190 | 211 | 240 | 277 | 232 |
<0.001
|
All other causes (n = 354,569) | 86 | 74 | 78 | 80 | 88 | 102 | 108 | 82 |
<0.001
|
Permanent vascular access used or in place at ESRD start, %
| |||||||||
All ESRD (n = 616,025) | 35.9% | 37.4% | 36.7% | 35.4% | 34.3% | 35.1% | 36.4% | 37.4% |
0.89
|
ESRD attributed to: | |||||||||
Lupus nephritis (n = 5,624) | 24.4% | 22.3% | 25.7% | 23.9% | 23.5% | 24.3% | 25.5% | 25.3% |
0.45
|
Other glomerulonephritis (n = 41,824) | 37.7% | 40.3% | 38.6% | 37.4% | 36.1% | 36.7% | 37.1% | 39.6% |
0.83
|
All other causes (n = 568,577) | 35.9% | 37.3% | 36.7% | 35.4% | 34.2% | 35.0% | 36.5% | 37.4% |
0.11
|
Quality of care measure
|
Risk ratio for attributed cause of ESRD (95% CI)
| ||
---|---|---|---|
Unadjusted
|
Adjusted*
| ||
Sociodemographic
|
Sociodemographic and clinical
| ||
Pre-ESRD care, yes vs. no (odds ratio)
| |||
All other causes | 1.00 (ref) | 1.00 (ref) | 1.00 (ref) |
Lupus nephritis | 1.64 (1.54–1.74) | 1.51 (1.42–1.61) | 1.68 (1.57–1.78) |
Other glomerulonephritis | 1.26 (1.23–1.28) | 1.19 (1.17–1.22) | 1.22 (1.19–1.24) |
Informed of transplant options, yes vs. no (odds ratio)
| |||
All other causes | 1.00 (ref) | 1.00 (ref) | 1.00 (ref) |
Lupus nephritis | 1.10 (1.02–1.19) | 1.09 (1.01–1.18) | 1.10 (1.02–1.19) |
Other glomerulonephritis | 1.19 (1.15–1.23) | 1.21 (1.17–1.25) | 1.19 (1.15–1.23) |
Time to placement on the kidney transplant waitlist (hazard ratio)
| |||
In 1st year of ESRD
| |||
All other causes | 1.00 (ref) | 1.00 (ref) | 1.00 (ref) |
Lupus nephritis | 2.29 (2.15–2.43) | 1.47 (1.39–1.57) | 1.42 (1.34–1.52) |
Other glomerulonephritis | 2.73 (2.66–2.80) | 2.00 (1.95–2.05) | 1.91 (1.86–1.96) |
After 1st year of ESRD
| |||
All other causes | 1.00 (ref) | 1.00 (ref) | 1.00 (ref) |
Lupus nephritis | 2.45 (2.29–2.63) | 1.60 (1.49–1.72) | 1.56 (1.45–1.67) |
Other glomerulonephritis | 1.90 (1.84–1.97) | 1.45 (1.40–1.50) | 1.39 (1.35–1.44) |
Permanent vascular access used/in place, yes vs. no (odds ratio)
| |||
All other causes | 1.00 (ref) | 1.00 (ref) | 1.00 (ref) |
Lupus nephritis | 0.57 (0.53–0.61) | 0.58 (0.55–0.62) | 0.63 (0.59–0.67) |
Other glomerulonephritis | 1.07 (1.05–1.10) | 1.07 (1.05–1.10) | 1.10 (1.07–1.12) |
Attributed cause of ESRD
|
Risk ratio* for attributed cause of ESRD (95% CI)
| ||||
---|---|---|---|---|---|
Diabetes and hypertension only as referent group
|
Additional adjustment for albumin
|
Among patients who never recovered renal function
|
Additional adjustment for age-squared
|
Additional adjustment for age × sex
| |
Pre-ESRD care, yes vs. no (odds ratio)
| |||||
All other causes | 1.00 (ref) | 1.00 (ref) | 1.00 (ref) | 1.00 (ref) | 1.00 (ref) |
Lupus nephritis | 1.56 (1.46–1.66) | 2.02 (1.88–2.17) | 1.69 (1.59–1.81) | 1.71 (1.61–1.82) | 1.55 (1.46–1.65) |
Other glomerulonephritis | 1.06 (1.04–1.09) | 1.20 (1.17–1.23) | 1.20 (1.18–1.23) | 1.23 (1.20–1.25) | 1.22 (1.19–1.24) |
Informed of transplant options, yes vs. no (odds ratio)
| |||||
All other causes | 1.00 (ref) | 1.00 (ref) | 1.00 (ref) | 1.00 (ref) | 1.00 (ref) |
Lupus nephritis | 0.98 (0.91–1.06) | 1.16 (1.06–1.26) | 1.11 (1.02–1.20) | 1.13 (1.04–1.22) | 1.09 (1.01–1.18) |
Other glomerulonephritis | 1.07 (1.03–1.10) | 1.19 (1.14–1.23) | 1.20 (1.16–1.24) | 1.20 (1.16–1.24) | 1.19 (1.15–1.23) |
Time to placement on the kidney transplant waitlist (hazard ratio)
| |||||
In 1st year of ESRD
| |||||
All other causes | 1.00 (ref) | 1.00 (ref) | 1.00 (ref) | 1.00 (ref) | 1.00 (ref) |
Lupus nephritis | 1.53 (1.43–1.63) | 1.53 (1.43–1.64) | 1.50 (1.41–1.59) | 1.44 (1.35–1.53) | 1.39 (1.31–1.48) |
Other glomerulonephritis | 2.01 (1.95–2.06) | 1.86 (1.81–1.92) | 1.88 (1.83–1.93) | 1.93 (1.88–1.98) | 1.91 (1.86–1.96) |
After 1st year of ESRD
| |||||
All other causes | 1.00 (ref) | 1.00 (ref) | 1.00 (ref) | 1.00 (ref) | 1.00 (ref) |
Lupus nephritis | 1.56 (1.45–1.67) | 1.69 (1.57–1.83) | 1.66 (1.54–1.78) | 1.57 (1.46–1.69) | 1.52 (1.42–1.63) |
Other glomerulonephritis | 1.36 (1.31–1.41) | 1.37 (1.32–1.42) | 1.38 (1.33–1.43) | 1.41 (1.36–1.46) | 1.39 (1.34–1.44) |
Permanent vascular access used/in place, yes vs. no (odds ratio)
| |||||
All other causes | 1.00 (ref) | 1.00 (ref) | 1.00 (ref) | 1.00 (ref) | 1.00 (ref) |
Lupus nephritis | 0.57 (0.53–0.60) | 0.63 (0.59–0.67) | 0.64 (0.60–0.69) | 0.73 (0.68–0.77) | 0.61 (0.57–0.65) |
Other glomerulonephritis | 0.97 (0.95–0.99) | 1.10 (1.07–1.12) | 1.09 (1.06–1.11) | 1.14 (1.12–1.17) | 1.10 (1.07–1.12) |