Atherosclerotic renovascular disease in older US patients starting dialysis, 1996 to 2001

被引:66
作者
Guo, Haifeng
Kalra, Philip A.
Gilbertson, David T.
Liu, Jiannong
Chen, Shu-Cheng
Collins, Allan J.
Foley, Robert N.
机构
[1] US Renal Data Syst, Coordinating Ctr, Minneapolis, MN 55404 USA
[2] Hope Hosp, Dept Renal Med, Salford M6 8HD, Lancs, England
[3] Univ Minnesota, Dept Med, Minneapolis, MN 55455 USA
关键词
atherosclerosis; epidemiology; kidney; revascularization;
D O I
10.1161/CIRCULATIONAHA.106.637751
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background - Temporal trends regarding the epidemiology of atherosclerotic renovascular disease (ARVD) in dialysis populations are poorly defined. Methods and Results - United States Renal Data System data were used to identify patients aged 67 years or older at dialysis inception between 1996 and 2001 (n = 146 973). Medicare claims in the preceding 2 years were used to identify ARVD and revascularization procedures. Prior ARVD rose from 7.1% to 11.2% between 1996 and 2001 (adjusted odds ratio [AOR], 1.68). Other associations included hypertensive end-stage renal disease (ESRD; AOR, 2.21), ESRD network (AOR, 0.44 in network 17 versus 1.00 in network 1), peripheral vascular disease ( AOR, 1.65), black race (AOR, 0.44), urologic cause of ESRD (AOR, 0.57), age > 85 years (AOR, 0.58), substance dependency (AOR, 0.62), and inability to ambulate or transfer (AOR, 0.67). The proportion of ARVD patients undergoing revascularization rose from 14.6% to 16.7% between 1996 and 2001 (AOR, 1.27). Other associations included hypertension (AOR, 2.10), ESRD network (AOR, 2.07 for network 13 versus 1.00 in network 1), age > 85 years ( AOR, 0.53), and black race (AOR, 0.54). The rise in ARVD was not reflected in the proportion of patients with renovascular disease listed as cause of ESRD on the Medical Evidence Report at dialysis inception (5.5% in 1996, 5.0% in 2001). Conclusions - ARVD diagnoses have become more common in older patients beginning dialysis therapy. The association of demographic factors including age, race, and geographic residence with utilization patterns suggests possible barriers to care.
引用
收藏
页码:50 / 58
页数:9
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