Changes in Medicare reimbursement and patient-nephrologist visits, quality of care, and health-related quality of life.

Background: Medicare's reimbursement system was changed in January 2004 to encourage more frequent visits between dialysis patients and nephrologists. We sought to determine the impact of this policy change on patient-nephrologist visits, quality of care, and health-related quality of life.

Methods: We examined visits and outcomes for 2,043 patients at 12 hemodialysis facilities in northeast Ohio for 12 months before and 7 months after the reimbursement change.

Blood pressure and progression of chronic kidney disease: importance of systolic, diastolic, or diurnal variation.

Several studies show that systolic blood pressure is an important predictor of renal disease progression, just as it is linked with cardiovascular consequences in hypertension. In contrast, particularly in older patients, diastolic blood pressure was not independently associated with risk of kidney disease progression in the same studies. Pulse pressure has been shown to be equivalent in predicting renal outcomes, but might not have added value after adjusting for systolic blood pressure.

Highly active antiretroviral therapy and the incidence of HIV-1-associated nephropathy: a 12-year cohort study.

Objective: to assess temporal changes in the incidence of human immunodeficiency virus-1-associated nephropathy (HIVAN), and the association with use of highly active antiretroviral therapy (HAART).

Methods: HIVAN incidence and risk factors were assessed in 3976 HIV-1-infected individuals followed in clinical cohort in Baltimore, Maryland, USA from 1989 to 2001. The incidence of HIVAN, defined by biopsy or a conservative uniformly applied clinical coding protocol, was expressed in terms of person-years, and Poisson regression was used for multivariate analysis.