The quality of cardiovascular disease care for adolescents with kidney disease: a Midwest Pediatric Nephrology Consortium study
- 276 Downloads
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.
KeywordsCardiovascular disease Transition Quality Chronic kidney disease Kidney transplantation Dialysis
Body mass index
Chronic kidney disease
Cardiovascular risk factor
End-stage renal disease
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).
Conflict of interest
- 2.North American Pediatric Renal Trials and Collaborative Studies (NAPRTCS) (2009) NAPRTCS 2008 annual report. North American Pediatric Renal Trials and Collaborative Studies. https://web.emmes.com/study/ped/annlrept/Archiveannlrept.html. Accessed 21 Oct 2012
- 5.Kasiske B, Cosio FG, Beto J, Bolton K, Chavers BM, Grimm R Jr, Levin A, Masri B, Parekh R, Wanner C, Wheeler DC, Wilson PW (2004) Clinical practice guidelines for managing dyslipidemias in kidney transplant patients: a report from the Managing Dyslipidemias in Chronic Kidney Disease Work Group of the National Kidney Foundation Kidney Disease Outcomes Quality Initiative. Am J Transplant 4(Suppl 7):13–53PubMedCrossRefGoogle Scholar
- 6.Kavey RE, Allada V, Daniels SR, Hayman LL, McCrindle BW, Newburger JW, Parekh RS, Steinberger J (2006) Cardiovascular risk reduction in high-risk pediatric patients: a scientific statement from the American Heart Association Expert Panel on Population and Prevention Science; the Councils on Cardiovascular Disease in the Young, Epidemiology and Prevention, Nutrition, Physical Activity and Metabolism, High Blood Pressure Research, Cardiovascular Nursing, and the Kidney in Heart Disease; and the Interdisciplinary Working Group on Quality of Care and Outcomes Research: endorsed by the American Academy of Pediatrics. Circulation 114:2710–2738PubMedCrossRefGoogle Scholar
- 7.Kidney Disease Outcomes Quality Initiative (K/DOQI) (2004) K/DOQI clinical practice guidelines on hypertension and antihypertensive agents in chronic kidney disease. Am J Kidney Dis 43:S1–290Google Scholar
- 8.Lurbe E, Cifkova R, Cruickshank JK, Dillon MJ, Ferreira I, Invitti C, Kuznetsova T, Laurent S, Mancia G, Morales-Olivas F, Rascher W, Redon J, Schaefer F, Seeman T, Stergiou G, Wuhl E, Zanchetti A (2009) Management of high blood pressure in children and adolescents: recommendations of the European Society of Hypertension. J Hypertens 27:1719–1742PubMedCrossRefGoogle Scholar
- 9.Kidney Disease: Improving Global Outcomes (KDIGO) Transplant Work Group (2009) KDIGO clinical practice guideline for the care of kidney transplant recipients. Am J Transplant 9(Suppl 3):S1–S157Google Scholar
- 11.National Kidney Foundation (2003) K/DOQI clinical practice guidelines for management of dyslipidemias in patients with kidney disease. Am J Kidney Dis 41(Suppl 3):I–IV, S1–S91Google Scholar
- 12.National Kidney Foundation (2005) K/DOQI clinical practice guidelines for cardiovascular disease in dialysis patients. Am J Kidney Dis 45:S1–S153Google Scholar
- 13.Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (2001) Executive summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 285:2486–2497CrossRefGoogle Scholar
- 16.Marcen R, del Castillo D, Capdevila L, Fernandez-Fresnedo G, Rodrigo E, Cantarell C, Fernandez-Rodriguez A, Lopez-Oliva MO, Camps J, Aljama P, Ortuno J, Arias M (2009) Achieving chronic kidney disease treatment targets in renal transplant recipients: results from a cross-sectional study in Spain. Transplantation 87:1340–1346PubMedCrossRefGoogle Scholar
- 17.Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents (2011) Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents: summary report. Pediatrics 128(Suppl 5):S213–S256CrossRefGoogle Scholar
- 25.Chesney RW, Brewer E, Moxey-Mims M, Watkins S, Furth SL, Harmon WE, Fine RN, Portman RJ, Warady BA, Salusky IB, Langman CB, Gipson D, Scheidt P, Feldman H, Kaskel FJ, Siegel NJ (2006) Report of an NIH task force on research priorities in chronic kidney disease in children. Pediatr Nephrol 21:14–25PubMedCrossRefGoogle Scholar
- 28.Agency for Healthcare Research and Quality (2010) National Healthcare Quality Report 2010. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/qual/nhqr10/nhqr10.pdf. Accessed 21 Oct 2012
- 33.American Academy of Pediatrics, American Academy of Family Physicians, American College of Physicians-American Society of Internal Medicine (2002) A consensus statement on health care transitions for young adults with special health care needs. Pediatrics 110:1304–1306Google Scholar
- 34.Healthy People 2010 Healthy and Ready to Work (HRTW)/Transition Work Group (2000) Draft 10-Year Healthy and Ready to Work Transition Plan. In: Maternal and Child Health Bureau, Division of Services for Children with Special health Care Needs, Washington DC. http://www.mchbhrtw.org/HP2010final.pdf. Accessed 21 Oct 2012
- 36.Institute of Medicine (2001) Crossing the quality chasm: a new health system for the 21st century. National Academy Press, Washington DCGoogle Scholar
- 40.Cadario F, Prodam F, Bellone S, Trada M, Binotti M, Allochis G, Baldelli R, Esposito S, Bona G, Aimaretti G (2009) Transition process of patients with type 1 diabetes (T1DM) from paediatric to the adult health care service: a hospital-based approach. Clin Endocrinol (Oxf) 71:346–350CrossRefGoogle Scholar