A study published in JAMA Network Open shows 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 better financial funding of nephrology as well as more efforts to raise awareness of kidney disease in the population.

The complexity of patients varies substantially between medical specialties. This is one of the findings of a Canadian retrospective population-based cohort study, involving more than 2.5 million participants. Another important finding is that nephrologists treat the most complex patients.

In this study, complexity was defined by nine markers:

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 authors point out, payment to healthcare facilities is frequently based on patient volume rather than on patient complexity. In their view, policymakers should account more for the complexity and invest more in the treatment of vulnerable patients.

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