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

Research output: Contribution to journalReview articlepeer-review

17 Scopus citations

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.

Original languageEnglish
Pages (from-to)939-949
Number of pages11
JournalPediatric Nephrology
Volume28
Issue number6
DOIs
StatePublished - Jun 2013

Keywords

  • Cardiovascular disease
  • Chronic kidney disease
  • Dialysis
  • Kidney transplantation
  • Quality
  • Transition

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