State Level Variations in Nephrology Workforce and Timing and Incidence of Dialysis in the United States Among Children and Adults: a Retrospective Cohort Study

Overview

Journal BMC Nephrol

Publisher Biomed Central

Specialty Nephrology

Date 2015 Jan 16

PMID 25589150

Citations 7

Authors

Elaine Ku

Kirsten L Johansen

Anthony A Portale

Barbara Grimes

Chi-Yuan Hsu

Affiliations

Soon will be listed here.

Abstract

Background: Multiple factors influence timing of dialysis initiation. The impact of supply of nephrology workforce on timing and incidence of dialysis initiation is not well known.

Methods: We determined the number of pediatric and adult nephrologists in each state using data from the American Medical Association and American Boards of Internal Medicine and Pediatrics. We ascertained state population data from the 2010 US Census. United States Renal Data System (USRDS) data were used to determine estimated glomerular filtration rate (eGFR) at dialysis initiation and dialysis incidence for adults (≥18 years) in 2008 and children (<18 years) in 2007-2009 by state.

Results: Across all states, there were a median of 3.0 (IQR 2.3 to 3.4) adult nephrologists per 100,000 adults and 0.5 (IQR 0.2 to 0.9) pediatric nephrologists per 100,000 children. The median eGFR at start of dialysis was 9.8 mL/min/1.73 m2 (IQR 7.1-13.1) in adults and 8.5 mL/min/1.73 m2 (IQR 6.2-11.4) in children. Neither the number of adult (Spearman r of 0.02 [95% CI -0.26-0.30], p = 0.88) nor pediatric (Spearman r of -0.13 [95% -0.39-0.15], p = 0.38) nephrologists per state population was associated with mean eGFR across states. The number of nephrologists per state population was associated with incident dialysis cases per state population in adults (Spearman r of 0.50 [95% CI 0.26-0.68], p = 0.0002), but not in children (Spearman r of -0.06 [95% CI -0.33-0.22], p = 0.67). In linear regression models, the association between nephrologists per state population and incident dialysis cases per state population remained statistically significant (p = 0.006) after adjustment for provider characteristics.

Conclusions: Nephrology workforce supply is aligned with demand but does not appear to be associated with timing of dialysis initiation.

Citing Articles

Enhancing primary care capacity in chronic kidney disease management: a quality improvement educational initiative.

Smekal M, Bello A, Donald M, Zaidi D, McBrien K, Nicholson K BMJ Open. 2021; 11(11):e046068.

PMID: 34753751 PMC: 8578991. DOI: 10.1136/bmjopen-2020-046068.

Capacity of Kidney Care in Canada: Identifying Barriers and Opportunities.

Lunney M, Samimi A, Osman M, Jindal K, Wiebe N, Ye F Can J Kidney Health Dis. 2019; 6:2054358119870540.

PMID: 31516717 PMC: 6719472. DOI: 10.1177/2054358119870540.

Starting Renal Replacement Therapy: Is It About Time?.

Ku E, McCulloch C, Johansen K Am J Nephrol. 2019; 50(2):144-151.

PMID: 31269487 PMC: 6667296. DOI: 10.1159/000501510.

Use of the Kidney Failure Risk Equation to Determine the Risk of Progression to End-stage Renal Disease in Children With Chronic Kidney Disease.

Winnicki E, McCulloch C, Mitsnefes M, Furth S, Warady B, Ku E JAMA Pediatr. 2017; 172(2):174-180.

PMID: 29255845 PMC: 5839269. DOI: 10.1001/jamapediatrics.2017.4083.

Timing of Dialysis Initiation: What Has Changed Since IDEAL?.

Rivara M, Mehrotra R Semin Nephrol. 2017; 37(2):181-193.

PMID: 28410652 PMC: 5407409. DOI: 10.1016/j.semnephrol.2016.12.008.

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