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The quality of cardiovascular disease care for adolescents with kidney disease: a Midwest Pediatric Nephrology Consortium study |
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| Authors: | David K. Hooper Jason C. Williams Adam C. Carle Sandra Amaral Deepa H. Chand Maria E. Ferris Hiren P. Patel Christoph Licht Gina-Marie Barletta Veronica Zitterman Mark Mitsnefes Uptal D. Patel |
| Affiliation: | 1. Division of Nephrology & Hypertension, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA 3. James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA 2. Pediatric Nephrology, Duke Children’s Hospital & Health Center, Durham, NC, USA 4. Pediatric Nephrology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA 5. Pediatric Nephrology, Rush Children’s Hospital, Chicago, IL, USA 6. Kidney Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA 7. Pediatric Nephrology, Nationwide Children’s Hospital, Columbus, OH, USA 8. Pediatric Nephrology, Hospital for Sick Children, Toronto, ON, Canada 9. Division of Pediatric Nephrology, Phoenix Children’s Hospital, Phoenix, AZ, USA 10. University of Michigan, Ann Arbor, MI, USA 11. Duke Clinical Research Institute, 2400 Pratt Street, P.O. Box 3646, Nephrology, Durham, NC, 27705, USA |
| Abstract: | BackgroundCardiovascular disease is the leading cause of increased mortality for adolescents with advanced kidney disease. The quality of preventive cardiovascular care may impact long-term outcomes for these patients.MethodsWe reviewed the records of 196 consecutive adolescents from eight centers with pre-dialysis chronic kidney disease, on dialysis or with a kidney transplant, who transferred to adult-focused providers. We compared cardiovascular risk assessment and therapy within and across centers. Predictors of care were assessed using multilevel models.ResultsOverall, 58 % (range 44–86 %; p?=?0.08 for variance) of five recommended cardiovascular risk assessments were documented. Recommended therapy for six modifiable cardiovascular risk factors was documented 57 % (26–76 %; p?=?0.09) of the time. Of these patients, 30 % (n?=?59) were reported to go through formal transition which was independently associated with a 21 % increase in composite cardiovascular risk assessment (p?p?p?=?0.045, respectively).ConclusionsAdolescents with kidney disease receive suboptimal preventive cardiovascular care, that may contribute to their high risk of future cardiovascular mortality. A great opportunity exists to improve outcomes for children with kidney disease by improving the reliability of preventive care that may include formal transition programs. |
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