Nephrology care prior to end-stage renal disease and outcomes among new ESRD patients in the USA

Background: Longer nephrology care before end-stage renal disease (ESRD) has been linked with better outcomes. Methods: We investigated whether longer pre-end-stage renal disease (ESRD) nephrology care was associated with lower mortalityatboththepatientandstatelevelsamong443 761incidentESRDpatientsidentifiedintheUSAbetween2006and2010. Results: Overall, 33% of new ESRD patients had received no prior nephrology care, while 28% had received care for >12 months. At the patient level, predictors of >12 months of nephrology care included having health insurance, white race, younger age, diabetes,hypertensionandUSregion.Longerpre-ESRDnephrologycarewasassociatedwithlower first-yearmortality(adjusted hazard ratio = 0.58 for >12 months versus no care; 95% confidence interval 0.57–0.59), higheralbumin and hemoglobin, choice of peritoneal dialysis and native fistula and discussion of transplantation options. Living in a statewith a 10% higher proportion of patients receiving >12 months of pre-ESRD care was associated with a 9.3% lower relative mortality rate, standardized for case mix (R 2 = 0.47; P < 0.001).