TSpace Repository School of Graduate Studies – Theses Master
Prevalence, Predictors, and Outcomes Associated with Late Start of Chronic Kidney Disease Care Amongst Adults with End-stage Renal Disease
Health Policy, Management and Evaluation
end-stage renal disease; dialysis; chronic kidney disease care; late referral; nephrology care; mortality; predictors; survival
Using Ontario health administrative data, we identified 12,143 adults with chronic kidney disease (CKD) who received outpatient nephrology care prior to start of renal replacement therapy (RRT) in order to study the effect of care-related factors in predicting late start of predialysis care (PDC, defined as first outpatient nephrology visit <6 months prior to RRT start) and to explore covariates which further quantify the PDC received. Lack of an usual provider of primary care (OR 0.76; 95%CI 0.66, 0.87) predicted late start of PDC. In addition to late start of PDC, number of nephrology visits (OR 0.97 per visit; 95% CI 0.96, 0.98), and having seen a nephrologist in only 1 or 2 of the 6 months prior to RRT start (OR 1.33; 95%CI 1.18, 1.51), were also independent predictors of one-year mortality, suggesting that other measures of PDC are needed to better characterize the care received.
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