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Dialysis patients may live longer if their kidney specialist sees fewer patients

Higher physician caseload linked with earlier deaths among dialysis patients

2013-08-09
(Press-News.org) Nephrologists whose dialysis patients had the best survival over six years had a significantly lower patient caseload than nephrologists whose patients had the worst survival. For every additional 50 patients cared for by a nephrologist, patients had a 2% higher risk of dying within six years. Worldwide, more than 1.5 million people are treated with hemodialysis.

Washington, DC (August 8, 2013) — Dialysis patients receiving treatment from kidney specialists with a higher patient caseload have a greater risk of dying prematurely than those receiving care from specialists with a lower caseload, according to a study appearing in an upcoming issue of the Journal of the American Society of Nephrology (JASN). The study is the first of its kind to examine the association between nephrologist caseload and mortality risk in a large urban US setting.

How many patients a physician sees may affect patients' health outcomes. To see if this is true for kidney specialists, many of whom take care of a large number of dialysis patients, Kamyar Kalantar-Zadeh, MD, MPH, PhD (University of California Irvine Medical Center) and his colleagues examined whether hemodialysis patients cared for by nephrologists with a higher patient caseload had a greater risk of dying prematurely than those receiving care from nephrologists with a lower caseload. A total of 41 nephrologists with a caseload of 50 to 200 dialysis patients from an urban California region were retrospectively ranked according to their dialysis patients' mortality rate between 2001 and 2007.

Among the major findings: Nephrologists whose dialysis patients had the best survival had a significantly lower patient caseload than nephrologists whose patients had the worst survival. For every additional 50 patients cared for by a nephrologist, patients had a 2% higher risk of dying during the study period.

"Our data suggest that patients receiving care from nephrologists with lower caseloads may have greater survival," said Dr. Kalantar-Zadeh. "Such data may help direct health policies and guidelines more effectively."

The authors noted that additional studies are needed to confirm findings and to explore mechanisms by which caseload influences patients' outcomes. More research is also needed to determine the caseload threshold above which the benefits of increased experience are outweighed by a deterioration in quality of care and patient outcomes.

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Study co-authors include Kevin T. Harley, MD, Elani Streja, MPH, PhD, Connie M. Rhee, MD, MSc, Csaba P. Kovesdy, MD, and Alpesh N. Amin, MD, MBA.

Disclosures: The authors reported no financial disclosures.

The article, entitled "Nephrologist Caseload and Hemodialysis Patient Survival in an Urban Cohort," will appear online at http://jasn.asnjournals.org/ on August 8, 2013, doi: 10.1681/ASN2013020123.

The content of this article does not reflect the views or opinions of The American Society of Nephrology (ASN). Responsibility for the information and views expressed therein lies entirely with the author(s). ASN does not offer medical advice. All content in ASN publications is for informational purposes only, and is not intended to cover all possible uses, directions, precautions, drug interactions, or adverse effects. This content should not be used during a medical emergency or for the diagnosis or treatment of any medical condition. Please consult your doctor or other qualified health care provider if you have any questions about a medical condition, or before taking any drug, changing your diet or commencing or discontinuing any course of treatment. Do not ignore or delay obtaining professional medical advice because of information accessed through ASN. Call 911 or your doctor for all medical emergencies.

Founded in 1966, and with more than 14,000 members, the American Society of Nephrology (ASN) leads the fight against kidney disease by educating health professionals, sharing new knowledge, advancing research, and advocating the highest quality care for patients.

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[Press-News.org] Dialysis patients may live longer if their kidney specialist sees fewer patients
Higher physician caseload linked with earlier deaths among dialysis patients