Featured Research

from universities, journals, and other organizations

Community poverty impacts pre-dialysis care

Date:
August 5, 2010
Source:
American Society of Nephrology
Summary:
The wealth or poverty of kidney disease patients' communities impacts the quality of care patients receive before starting dialysis, according to a new study. The results suggest that medical professionals need to improve care for patients who have not yet started dialysis.

The wealth or poverty of kidney disease patients' communities impacts the quality of care patients receive before starting dialysis, according to a study appearing in an upcoming issue of the Journal of the American Society Nephrology (JASN). The results suggest that medical professionals need to improve care for patients who have not yet started dialysis.

For patients with end-stage renal disease (ESRD) who must begin the use of dialysis to do the work their kidneys can no longer do, experts strongly recommend creating an arteriovenous fistula (AVF). An AVF connects a vein and an artery, usually in the forearm, to allow an efficient and convenient connection to a dialysis machine, and to provide a long-lasting site through which blood can be removed and returned.

Research demonstrates substantial variations in the care that kidney disease patients receive before beginning dialysis. William McClellan, MD (Emory University) and his colleagues studied the degree to which AVF use in kidney disease patients is associated with the level of poverty in the county where a treatment center is located.

The investigators studied 28,135 patients who were treated by 1,127 dialysis centers within 16 states between June 1, 2005 and May 31, 2006. They found that among newly identified dialysis patients at treatment centers in poorer communities, patients were less likely to receive an AVF. (Among patients already on dialysis in those centers, AVF rates increased substantially over the 30 months of observation, from 30.9% to 38.6%, and there was no association between a county's wealth or poverty and the rate of change in AVF use.)

"The community where a treatment center resides may contribute to variations in pre-dialysis care. This observation provides support for developing ways to improve quality of care in these poorly performing communities and raises questions as to why poverty plays a role in pre-dialysis care, when these variations are not seen following the start of dialysis," said Dr. McClellan.

The study authors suspect that the knowledge of local primary care physicians might vary, leading to delays in referrals for AVF placement. Also, poorer communities might negatively influence opinions, attitudes, and beliefs among individuals with advanced kidney disease about the utility of early AVF surgery.

The lack of community-to-community variation after patients start dialysis may result from support provided the Medicare ESRD program. Medicare reimburses the costs of ESRD care for all individuals eligible for Social Security benefits regardless of other patient characteristics. In Dr. McClellan's study, improvement in AVF use among patients already on dialysis was measured during a national systematic effort to improve AVF rates through a program called Fistula First.

Study co-authors include Haimanot Wasse, MD, Ann McClellan, PhD, Lance Waller, PhD (Emory University); James Holt, PhD (Centers for Disease Control and Prevention); and Jenna Krisher (ESRD Network 6).


Story Source:

The above story is based on materials provided by American Society of Nephrology. Note: Materials may be edited for content and length.


Journal Reference:

  1. McClellan et al. Geographic Concentration of Poverty and Arteriovenous Fistula Use among ESRD Patients. Journal of the American Society Nephrology, August 5, 2010 DOI: 10.1681/ASN.2009121235

Cite This Page:

American Society of Nephrology. "Community poverty impacts pre-dialysis care." ScienceDaily. ScienceDaily, 5 August 2010. <www.sciencedaily.com/releases/2010/08/100805172943.htm>.
American Society of Nephrology. (2010, August 5). Community poverty impacts pre-dialysis care. ScienceDaily. Retrieved April 16, 2014 from www.sciencedaily.com/releases/2010/08/100805172943.htm
American Society of Nephrology. "Community poverty impacts pre-dialysis care." ScienceDaily. www.sciencedaily.com/releases/2010/08/100805172943.htm (accessed April 16, 2014).

Share This



More Health & Medicine News

Wednesday, April 16, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Could Even Casual Marijuana Use Alter Your Brain?

Could Even Casual Marijuana Use Alter Your Brain?

Newsy (Apr. 16, 2014) A new study conducted by researchers at Northwestern and Harvard suggests even casual marijuana use can alter your brain. Video provided by Newsy
Powered by NewsLook.com
Ebola Outbreak Now Linked To 121 Deaths

Ebola Outbreak Now Linked To 121 Deaths

Newsy (Apr. 15, 2014) The ebola virus outbreak in West Africa is now linked to 121 deaths. Health officials fear the virus will continue to spread in urban areas. Video provided by Newsy
Powered by NewsLook.com
Cognitive Function: Is It All Downhill From Age 24?

Cognitive Function: Is It All Downhill From Age 24?

Newsy (Apr. 15, 2014) A new study out of Canada says cognitive motor performance begins deteriorating around age 24. Video provided by Newsy
Powered by NewsLook.com
How Mt. Everest Helped Scientists Research Diabetes

How Mt. Everest Helped Scientists Research Diabetes

Newsy (Apr. 15, 2014) British researchers were able to use Mount Everest's low altitudes to study insulin resistance. They hope to find ways to treat diabetes. Video provided by Newsy
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:
from the past week

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins