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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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Abstract

Background

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.

Methods

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.

Results

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).

Conclusions

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.

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Abbreviations

BMI:

Body mass index

CKD:

Chronic kidney disease

CVD:

Cardiovascular disease

CVRF:

Cardiovascular risk factor

ESRD:

End-stage renal disease

LDL:

Low-density lipoprotein

TXP:

Kidney transplant

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Acknowledgments

The authors wish to acknowledge their appreciation of the cooperation of the Midwest Pediatric Nephrology Consortium and the efforts of our outstanding coordinators and staff for their assistance with data abstraction: L. Patterson (Duke University Children’s Hospital & Health Center), M. Kamel (Emory University and Children’s Healthcare of Atlanta), T. Crumb (DeVos Children’s Hospital), J. Kester (Children’s Hospital Akron), K. Bickford (University of North Carolina), and M. Frieling (Sick Kids Hospital, Toronto). This study was supported in part by the Department of Pediatrics at Duke University and a career development award to Dr. Patel from the National Institutes of Health (NIH) and the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK; grant K23 DK075929).

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None.

Author information

Authors and Affiliations

  1. Division of Nephrology & Hypertension, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    David K. Hooper & Mark Mitsnefes

  2. Pediatric Nephrology, Duke Children’s Hospital & Health Center, Durham, NC, USA

    Jason C. Williams & Uptal D. Patel

  3. James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    David K. Hooper & Adam C. Carle

  4. Pediatric Nephrology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Sandra Amaral

  5. Pediatric Nephrology, Rush Children’s Hospital, Chicago, IL, USA

    Deepa H. Chand

  6. Kidney Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Maria E. Ferris

  7. Pediatric Nephrology, Nationwide Children’s Hospital, Columbus, OH, USA

    Hiren P. Patel

  8. Pediatric Nephrology, Hospital for Sick Children, Toronto, ON, Canada

    Christoph Licht

  9. Division of Pediatric Nephrology, Phoenix Children’s Hospital, Phoenix, AZ, USA

    Gina-Marie Barletta

  10. University of Michigan, Ann Arbor, MI, USA

    Veronica Zitterman

  11. Duke Clinical Research Institute, 2400 Pratt Street, P.O. Box 3646, Nephrology, Durham, NC, 27705, USA

    Uptal D. Patel

Authors
  1. David K. Hooper
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  2. Jason C. Williams
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  3. Adam C. Carle
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  4. Sandra Amaral
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  5. Deepa H. Chand
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  6. Maria E. Ferris
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  7. Hiren P. Patel
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  8. Christoph Licht
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  9. Gina-Marie Barletta
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  10. Veronica Zitterman
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  11. Mark Mitsnefes
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  12. Uptal D. Patel
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Corresponding author

Correspondence to Uptal D. Patel.

Additional information

During this study G.-M. Barletta was affiliated with DeVos Children’s Hospital, S. Amaral was affiliated with Children’s Healthcare of Atlanta and V. Zitterman was affiliated with Children’s Hospital of Michigan.

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Hooper, D.K., Williams, J.C., Carle, A.C. et al. The quality of cardiovascular disease care for adolescents with kidney disease: a Midwest Pediatric Nephrology Consortium study . Pediatr Nephrol 28, 939–949 (2013). https://doi.org/10.1007/s00467-013-2419-6

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  • DOI: https://doi.org/10.1007/s00467-013-2419-6

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