Outpatient care improves kidney patients' survival

By David Douglas

NEW YORK (Reuters Health) - Outpatient care focusing on improving kidney function is associated with a reduced risk of death in patients with diabetes and chronic kidney disease, researchers report in the Archives of Internal Medicine.

This study extends previous findings indicating that consistent care started early by a kidney specialist may lower the risk of death in patients with diabetes and chronic kidney disease who have not begun dialysis yet, lead investigator Dr. Chin-Lin Tseng told Reuters Health.

Tseng, of the Department of Veterans Affairs New Jersey Health Care System, East Orange, and colleagues note that the survival impact of these interventions is uncertain.

To investigate further, the researchers analyzed data collected over 3 years on more than 39,000 such patients with severe kidney disease.

Compared to patients who had not seen a nephrologist, the team found that patients who had made two visits over 12 months, had a 20 percent lower risk of death during a follow-up period of around 19.3 months. For patients who had made four visits, the corresponding reduction was by 55 percent.

Some 17.8 percent of patients died during follow-up, and more than 93 percent of patients overall did not visit a nephrologist.

"Greater consistency of care is associated with greater decreases in mortality, but only a minority of patients received nephrologic care," the authors write.

In fact, concluded Tseng, "a new care model may be needed to respond to the treatment demands of a rapidly increasing number of patients with chronic kidney diseases by a limited number of practicing nephrologists.

SOURCE: Archives of Internal Medicine, January 14, 2008.