More than 600,000 Americans in 2012 were treated for kidney failure (end-stage renal disease or ESRD). A growing body of evidence indicates that many of these patients could have experienced successful interventions if treated at an earlier stage of the disease. In a study appearing in an upcoming issue of the Clinical Journal of the American Society of Nephrology (CJASN) (published ahead of print last month), Guofen Yan and fellow researchers from UVA and elsewhere shed light on some of the causes of variations in early stage care at the state level.
“This study examined interstate differences in receipt of predialysis nephrologist care (defined as nephrology care for 12 or more months before ESRD onset) among 373,986 adults who initiated ESRD treatment in the United States during 2005–2009,” Yan writes. “There is a considerable variation across states in the receipt of predialysis nephrologist care. Approximately one half to two thirds of this variation was attributable to state-level differences in general health care access, delivery of preventative care, and proxies of socioeconomic status.”
In an editorial accompanying the publication of Yan’s findings, Yoshio Hall, MD and Jonathan Himmelfarb, MD write “the study by Yan et al. provides timely estimates of whether and to what extent variation in state-level policy and resources might influence access to predialysis nephrology care. In the wake of the ACA implementation, the nephrology community eagerly awaits additional studies investigating area- and individual level changes in access to and quality measures of both primary and specialty care.”
“These findings shed light on the direction for public health policies that will be necessary to reduce disparities and achieve the Healthy People 2020 goals of improving nephrologist care for patients with advanced chronic kidney disease,” Yan writes. The study is funded by NIH/NIDDK R01 grant.