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ORIGINAL ARTICLE
Year : 2014  |  Volume : 42  |  Issue : 1  |  Page : 14-20

Early referral to nephrologist is required for improving outcome of chronic kidney disease patients


Department of Nephrology, Faculty of Medicine, Benha University, Egypt

Correspondence Address:
Mohamed F.T. Almaghraby
Department of Nephrology, Faculty of Medicine, Benha University, Benha
Egypt
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DOI: 10.4103/1110-1415.130092

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Objective The aim of our study was to evaluate the impact of late referral (LR) on health parameters and mortality rate of chronic kidney disease (CKD) patients. Patients and methods This retrospective study includes patients referred to the Renal Replacement Therapy Unit. Patients were classified as early referrals (ERs) if their first encounter with a nephrologist occurred within 16 weeks before initiation of dialysis and all others patients were considered LRs. Collected data included constitutional data, data on underlying kidney diseases, clinical and laboratory data, and the modified Charlson comorbidity index (CCI). The outcomes of the study are presented as the follow-up mortality rates in both groups and their relationship with the timing of referral and collected data. Results The study included 370 CKD patients: 140 ERs and 230 LRs. Patients of the LR group had significantly higher blood pressure (BP) and CCI scores compared with those of the ER group. Laboratory data showed significantly lower hemoglobin concentration and estimated glomerular filtration rate (eGFR) with significantly higher serum phosphate, total cholesterol, and low-density lipoprotein levels in the LR group compared with the ER group. Thirty-one patients (8.4%) died: six from the ER group and 25 from the LR group, with a significantly higher mortality rate in the LR group compared with the ER group. Survival was negatively correlated with time till referral, age, CCI, BP, and multiplicity of associated comorbidities, whereas it was positively correlated with female sex and high eGFR. Statistical analyses showed that high CCI and low eGFR were significant specific predictors, whereas old age, LR, and high systolic BP were significant sensitive predictors for mortality. In the Cox regression analysis, the survival rate in ER patients was significantly better than that in LR patients after adjusting for several risk factors. Conclusion ER of CKD patients to a nephrologist significantly minimizes morbidities and improves the chances of survival, which is significantly affected by age, multiplicity of associated comorbidities, and GFR. Improving the knowledge of patients and general physicians on the hazards of LR to nephrologists will definitely improve the outcome of patients with CKD.


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