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Explaining trends and variation in timing of dialysis initiation in the United States.

Abstract The United States Renal Data System (USRDS) registry of end-stage renal disease has often been used to study the timing of dialysis initiation, measured by estimated glomerular filtration rate (eGFR) at dialysis initiation. We conducted an observational study and examined how well variables in the USRDS database explain the trends and variation in eGFR at dialysis initiation.We identified 971,481 patients who initiated dialysis between 1995 and 2012 in the USRDS registry.The mean eGFR at dialysis initiation monotonically rose from 7.7 in 1995 to 11.1 in 2009, and then leveled off to 10.9 mL/min/1.73 m in 2012. The trend of rising, then leveling off was similar across all subgroups studied. Substantial variation in eGFR at dialysis initiation was observed, with standard deviation of 4.38 (95% CI: 2.0-18.4). A total of 11.4% of the total variation occurred across physicians and 88.6% within physicians. Adjustment for measured factors only modestly decreased the total variation. Of the total variance, 10.7% was explained by measured patient-level variables and 1.2% by measured physician and other factors, while 9.2% of physician-level variation and 78.9% of patient-level variation remained unexplained. The extent of variation explained by measured variables was similar over the entire study period.The finding that the majority of variation in eGFR at dialysis initiation is unexplained by measured variables casts doubt on how well eGFR serves as a measure for "timing" of dialysis initiation, and it indicates the need to collect more focused data to gain understanding of factors that affect timing of dialysis initiation in the US.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title medicine
Publication Year Start




PMID- 28514305
OWN - NLM
STAT- MEDLINE
DA  - 20170517
DCOM- 20170613
LR  - 20170613
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 96
IP  - 20
DP  - 2017 May
TI  - Explaining trends and variation in timing of dialysis initiation in the United
      States.
PG  - e6911
LID - 10.1097/MD.0000000000006911 [doi]
AB  - The United States Renal Data System (USRDS) registry of end-stage renal disease
      has often been used to study the timing of dialysis initiation, measured by
      estimated glomerular filtration rate (eGFR) at dialysis initiation. We conducted 
      an observational study and examined how well variables in the USRDS database
      explain the trends and variation in eGFR at dialysis initiation.We identified
      971,481 patients who initiated dialysis between 1995 and 2012 in the USRDS
      registry.The mean eGFR at dialysis initiation monotonically rose from 7.7 in 1995
      to 11.1 in 2009, and then leveled off to 10.9 mL/min/1.73 m in 2012. The trend of
      rising, then leveling off was similar across all subgroups studied. Substantial
      variation in eGFR at dialysis initiation was observed, with standard deviation of
      4.38 (95% CI: 2.0-18.4). A total of 11.4% of the total variation occurred across 
      physicians and 88.6% within physicians. Adjustment for measured factors only
      modestly decreased the total variation. Of the total variance, 10.7% was
      explained by measured patient-level variables and 1.2% by measured physician and 
      other factors, while 9.2% of physician-level variation and 78.9% of patient-level
      variation remained unexplained. The extent of variation explained by measured
      variables was similar over the entire study period.The finding that the majority 
      of variation in eGFR at dialysis initiation is unexplained by measured variables 
      casts doubt on how well eGFR serves as a measure for "timing" of dialysis
      initiation, and it indicates the need to collect more focused data to gain
      understanding of factors that affect timing of dialysis initiation in the US.
FAU - Li, Yun
AU  - Li Y
AD  - aArbor Research Collaborative for Health bUniversity of Michigan, Ann Arbor, MI, 
      USA.
FAU - Jin, Yan
AU  - Jin Y
FAU - Kapke, Alissa
AU  - Kapke A
FAU - Pearson, Jeffrey
AU  - Pearson J
FAU - Saran, Rajiv
AU  - Saran R
FAU - Port, Friedrich K
AU  - Port FK
FAU - Robinson, Bruce M
AU  - Robinson BM
LA  - eng
GR  - HHSN276201400001C/LM/NLM NIH HHS/United States
PT  - Journal Article
PT  - Observational Study
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
SB  - AIM
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Female
MH  - Glomerular Filtration Rate
MH  - Humans
MH  - Kidney Failure, Chronic/epidemiology/*therapy
MH  - Male
MH  - Middle Aged
MH  - Registries
MH  - Renal Dialysis/*trends
MH  - Time-to-Treatment/trends
MH  - United States
MH  - Young Adult
PMC - PMC5440142
EDAT- 2017/05/18 06:00
MHDA- 2017/06/14 06:00
CRDT- 2017/05/18 06:00
AID - 10.1097/MD.0000000000006911 [doi]
AID - 00005792-201705190-00022 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2017 May;96(20):e6911. doi: 10.1097/MD.0000000000006911.

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