Kidney patients are the most complex patients

Europe Uncategorized

A study published in JAMA [1] 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 “European Renal Association – European Dialysis and Transplant Association” (ERA-EDTA) it is time for a paradigm shift. There is a  need 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.”

[1] Marcello Tonelli et al. Comparison of the Complexity of Patients Seen by Different Medical Subspecialists in a Universal Health Care System.

JAMA Netw Open. 2018;1(7):e184852. doi:10.1001/jamanetworkopen.2018.4852

With more than 11,000 members, the ERA-EDTA (“European Renal Association – European Dialysis and Transplant Association”) is one of the biggest nephrology associations worldwide and one of the most important and prestigious European Medical Associations. It supports basic and clinical research in the fields of clinical nephrology, dialysis, renal transplantation and related subjects. It also supports a number of studies as well as research groups and has founded a special “Fellowship Programme” for young investigators as well as grant programmes. In order to involve young nephrologists in all its activities, ERA-EDTA has created the “Young Nephrologists’ Platform” (YNP), a very active committee whose board includes members who are 40 years old or younger. In addition, it has established various working groups to promote the collaboration of nephrologists with other medical disciplines (e.g. cardiology, immunology). Furthermore, a “European Renal Best Practice” (ERBP) advisory board was established by the ERA-EDTA to draw up and publish guidelines and position statements. Another important goal of the ERA-EDTA is education: The series of CME courses combined with the annual congress offer an attractive scientific programme to cover the need for continuous medical education for doctors working in the fields of nephrology, dialysis and transplantation. The association’s journals, NDT (Nephrology, Dialysis, Transplantation) and CKJ (Clinical Kidney Journal), are currently the leading nephrology journals in Europe; furthermore NDT-Educational is the Society’s online educational journal , with free access for all users, as well as being a very important and useful feature of the NDT-Educational “Literature Review”. The ERA-EDTA Registry is a large epidemiologic database comparing countries by assessing nephrology practices throughout Europe. ENP, the European Nephrology Portal, is the latest new initiative of ERA-EDTA, where all those interested in the activities of the Society can find everything that is happening, all in one place. Finally, ERA-EDTA is a member of the European Kidney Health Alliance (EKHA), a consortium of patients, nurses and foundations relating to renal issues that actively interacts with the European Parliament.