Physician access and early nephrology care in elderly patients with end-stage renal disease

UMMS Affiliation

Department of Quantitative Health Sciences

Publication Date


Document Type



Aged; Aged, 80 and over; Geriatrics; Health Services Accessibility; Humans; Kidney Failure, Chronic; Nephrology; Physicians; Renal Dialysis; United States


Biostatistics | Epidemiology | Health Services Research | Nephrology


Early nephrology care may improve treatment outcomes of patients with end-stage renal disease. We sought to examine if physician access affects early nephrology care defined as visiting a nephrologist 12 to 4 months before initiating dialysis. The study population consisted of elderly patients starting hemodialysis whose demographic characteristics and initial dialysis therapy were derived from form 2728 files of the Centers for Medicare & Medicaid Services. Early nephrology care, chronic kidney disease and co-morbidities along with access to local non-nephrologist physicians and nephrologists were identified based on Medicare claims and/or United States 2000 Census data. About one-third of elderly patients received early nephrology care prior to initiating dialysis. Patients living in an area with a large number of non-nephrologist physicians or living relatively far away from a nephrologist had a lower likelihood of getting early nephrology care prior to initiating dialysis while those in an area with more practicing nephrologists were more likely to get early nephrology care. The study shows that physician access significantly influences the use of early nephrology care among elderly patients progressing to end-stage renal disease in the United States.


Zhao Y, Brooks JM, Flanigan MJ, Chrischilles EA, Pendergast JF, Hunsicker LG. 2008. Physician access and early nephrology care in elderly patients with end-state renal disease, Kidney Imemational74 (12): 1596-1602.

Journal/Book/Conference Title

Kidney international

PubMed ID


Related Resources

Link to article in PubMed