TY - JOUR
T1 - Comanagement With Nephrologist Care Is Associated With Fewer Cardiovascular Events Among Liver Transplant Recipients With Chronic Kidney Disease
AU - Campbell, Patrick T.
AU - Kosirog, Megan
AU - Aghaulor, Blessing
AU - Gregory, Dyanna
AU - Pine, Stewart
AU - Daud, Amna
AU - Das, Arighno
AU - Finn, Daniel J.
AU - Levitsky, Josh
AU - Holl, Jane L.
AU - Lloyd-Jones, Donald M.
AU - Vanwagner, Lisa B.
N1 - Funding Information:
This work was supported by a grant from the National Institutes of Health/National Heart, Lung, and Blood Institute to L.B.V. (K23HL136891). The Northwestern Medicine Enterprise Data Warehouse is funded, in part, by the National Center for Advancing Translational Sciences of the National Institute of Health research grant UL1TR001422 to the Northwestern University Clinical and Translational Sciences Institute.
Publisher Copyright:
© 2021 Wolters Kluwer Health. All rights reserved.
PY - 2021/9/20
Y1 - 2021/9/20
N2 - Background. Chronic kidney disease (CKD) is associated with cardiovascular (CV) events, a leading complication in liver transplant recipients (LTRs). Timely subspecialty care is associated with improved clinical outcomes in patients with CKD. This study sought to assess associations between nephrology comanagement and CV events among LTRs at risk for or with CKD. Methods. LTRs with CKD plus those at risk were identified in an inception cohort at a single tertiary care network between 2010 and 2016, using electronic health record data and manual chart review. CKD was defined as estimated glomerular filtration rate <60 mL/min/1.73 m2or International Classification of Diseases 9th or 10th revision code for CKD and at-risk CKD as estimated glomerular filtration rate 60-89 mL/min/1.73 m2. Cox proportional hazard models assessed the association between nephrology comanagement and CV events among LTRs with or at risk for CKD. Results. Among 602 LTRs followed for up to 6 y posttransplant, prevalence of CKD plus those at risk increased yearly (71% in year 1, 86% in year 6) (P < 0.0001). Rates of nephrology comanagement decreased yearly posttransplant (35% in year 1, 28% in year 6). In multivariable models, nephrology comanagement was associated with lower CV events (adjusted hazard ratio, 0.57; 95% confidence interval, 0.33-0.99). Conclusions. Among LTRs with CKD, nephrology comanagement may be associated with lower CV events. A prospective study is needed to identify the reasons for improved outcomes and barriers to nephrology referral.
AB - Background. Chronic kidney disease (CKD) is associated with cardiovascular (CV) events, a leading complication in liver transplant recipients (LTRs). Timely subspecialty care is associated with improved clinical outcomes in patients with CKD. This study sought to assess associations between nephrology comanagement and CV events among LTRs at risk for or with CKD. Methods. LTRs with CKD plus those at risk were identified in an inception cohort at a single tertiary care network between 2010 and 2016, using electronic health record data and manual chart review. CKD was defined as estimated glomerular filtration rate <60 mL/min/1.73 m2or International Classification of Diseases 9th or 10th revision code for CKD and at-risk CKD as estimated glomerular filtration rate 60-89 mL/min/1.73 m2. Cox proportional hazard models assessed the association between nephrology comanagement and CV events among LTRs with or at risk for CKD. Results. Among 602 LTRs followed for up to 6 y posttransplant, prevalence of CKD plus those at risk increased yearly (71% in year 1, 86% in year 6) (P < 0.0001). Rates of nephrology comanagement decreased yearly posttransplant (35% in year 1, 28% in year 6). In multivariable models, nephrology comanagement was associated with lower CV events (adjusted hazard ratio, 0.57; 95% confidence interval, 0.33-0.99). Conclusions. Among LTRs with CKD, nephrology comanagement may be associated with lower CV events. A prospective study is needed to identify the reasons for improved outcomes and barriers to nephrology referral.
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U2 - 10.1097/TXD.0000000000001220
DO - 10.1097/TXD.0000000000001220
M3 - Article
C2 - 34557583
AN - SCOPUS:85116993230
SN - 2373-8731
VL - 7
SP - E766
JO - Transplantation Direct
JF - Transplantation Direct
IS - 10
ER -