The quality of cardiovascular disease care for adolescents with kidney disease: a Midwest Pediatric Nephrology Consortium study
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Cardiovascular 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.
We 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.
Overall, 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 < 0.001). Transfer after 2006 and kidney transplant status were also associated with increased cardiovascular risk assessment (p < 0.01 and p = 0.045, respectively).
Adolescents 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.
- The quality of cardiovascular disease care for adolescents with kidney disease: a Midwest Pediatric Nephrology Consortium study
Volume 28, Issue 6 , pp 939-949
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- Cardiovascular disease
- Chronic kidney disease
- Kidney transplantation
- Industry Sectors
- Author Affiliations
- 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