A study published in JAMA Network Open showed: nephrologists treat the most complex patients. As ERA-EDTA president Professor Carmine Zoccali explains, kidney patients are highly vulnerable and need special care, but nephrology is a neglected discipline in many European healthcare systems. According to the ERA-EDTA it is time for a better financial funding of nephrology as well as more efforts to raise awareness for kidney disease in the population.
The complexity of patients varies substantially between different medical specialties. This is one of the findings of a Canadian retrospective population-based cohort study, in which more than 2.5 million participants were analysed. Another important finding is that nephrologists treat the most complex patients.
In this study, complexity was defined by nine markers: (1) the number of comorbidities, (2) the presence of mental illness, (3) the number of types of physicians involved, (4) the number of physicians involved, (5) the number of prescribed medications, (6) the number of emergency department visits, (7) the rate of adverse clinical outcomes (death, hospitalisation), (8) the risk of being placed in long-term care, and (9) the risk of death due to all causes. Over the follow-up period of one year 21,792 patients (0.8%) died and 217,920 (8%) were hospitalised.
The study showed that kidney patients had the highest number of comorbidities, the highest number of pills to take and the highest risk of placement in a long-term facility and the highest risk of mortality. They were second (after patients with infectious disease) when it came to number of physicians and the number of types of physicians they saw as well as the average length of their hospital stays.
As the study authors pointed out, payment to healthcare facilities is frequently based on patient volume rather than on patient complexity. In their view, policy makers should account more for the complexity and invest more in the treatment of vulnerable patients.
"This is a very important conclusion", explains ERA-EDTA president Professor Carmine Zoccali. "The study showed that kidney patients are the most complex and vulnerable patients, but in many European health systems nephrology is neglected compared with other medical disciplines. This does not only involve financial funding and infrastructure, but also the image and reputation of nephrology and the public awareness for kidney diseases. Against the background of this study´s findings we have to increase our efforts to raise awareness about how to prevent chronic kidney disease."