Pediatric Nephrology

, Volume 28, Issue 6, pp 939–949 | Cite as

The quality of cardiovascular disease care for adolescents with kidney disease: a Midwest Pediatric Nephrology Consortium study

  • David K. Hooper
  • Jason C. Williams
  • Adam C. Carle
  • Sandra Amaral
  • Deepa H. Chand
  • Maria E. Ferris
  • Hiren P. Patel
  • Christoph Licht
  • Gina-Marie Barletta
  • Veronica Zitterman
  • Mark Mitsnefes
  • Uptal D. Patel
Original Article

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.

Keywords

Cardiovascular disease Transition Quality Chronic kidney disease Kidney transplantation Dialysis 

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

Notes

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).

Financial disclosure

None.

Conflict of interest

None.

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Copyright information

© IPNA 2013

Authors and Affiliations

  • David K. Hooper
    • 1
    • 3
  • Jason C. Williams
    • 2
  • Adam C. Carle
    • 3
  • Sandra Amaral
    • 4
  • Deepa H. Chand
    • 5
  • Maria E. Ferris
    • 6
  • Hiren P. Patel
    • 7
  • Christoph Licht
    • 8
  • Gina-Marie Barletta
    • 9
  • Veronica Zitterman
    • 10
  • Mark Mitsnefes
    • 1
  • Uptal D. Patel
    • 2
    • 11
  1. 1.Division of Nephrology & HypertensionCincinnati Children’s Hospital Medical CenterCincinnatiUSA
  2. 2.Pediatric NephrologyDuke Children’s Hospital & Health CenterDurhamUSA
  3. 3.James M. Anderson Center for Health Systems ExcellenceCincinnati Children’s Hospital Medical CenterCincinnatiUSA
  4. 4.Pediatric NephrologyChildren’s Hospital of PhiladelphiaPhiladelphiaUSA
  5. 5.Pediatric NephrologyRush Children’s HospitalChicagoUSA
  6. 6.Kidney CenterUniversity of North Carolina at Chapel HillChapel HillUSA
  7. 7.Pediatric NephrologyNationwide Children’s HospitalColumbusUSA
  8. 8.Pediatric NephrologyHospital for Sick ChildrenTorontoCanada
  9. 9.Division of Pediatric NephrologyPhoenix Children’s HospitalPhoenixUSA
  10. 10.University of MichiganAnn ArborUSA
  11. 11.Duke Clinical Research InstituteDurhamUSA

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