Late referral of end-stage renal failure

• Published in: QJM : An International Journal of Medicine 1998-11, Vol.91 (11), p.727-732
• Main Authors: ELLIS, P. A, REDDY, V, BARI, N, CAIRNS, H. S
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Antihypertensive Agents - therapeutic use; Biological and medical sciences; Cohort Studies; Creatinine - blood; Female; Hospitalization; Humans; Hypertension - drug therapy; Kidney Failure, Chronic - blood; Kidney Failure, Chronic - etiology; Kidney Failure, Chronic - therapy; Male; Medical sciences; Middle Aged; Prevention and actions; Public health. Hygiene; Public health. Hygiene-occupational medicine; Referral and Consultation - statistics & numerical data; Renal Dialysis; Renal Replacement Therapy - statistics & numerical data; Specific populations (family, woman, child, elderly...); Time Factors; Treatment Outcome
• ISSN: 1460-2725; 1460-2393; 1460-2393
• DOI: 10.1093/qjmed/91.11.727

We studied all new patients accepted for renal replacement therapy (RRT) in one unit from 1/1/96 to 31/12/97 (n = 198), to establish time from nephrology referral to RRT, evidence of renal disease prior to referral and the adequacy of renal management prior to referral. Sixty four (32.3%, late referral group) required RRT within 12 weeks of referral. Fifty-nine (29.8%) had recognizable signs of chronic renal failure > 26 weeks prior to referral. Patients starting RRT soon after referral were hospitalized for significantly longer on starting RRT (RRT within 12 weeks of referral, median hospitalization 25.0 days (n = 64); RRT > 12 weeks after referral, median 9.7 days (n = 126), (p < 0.001)). Observed survival at 1 year was 68.3% overall, with 1-year survival of the late referral and early referral groups being 60.5% and 72.5%, respectively (p = NS). Hypertension was found in 159 patients (80.3%): 46 (28.9%) were started on antihypertensive medication following referral, while a further 28 (17.6%) were started on additional antihypertensives. Of the diabetic population (n = 78), only 26 (33.3%) were on an angiotensin-converting-enzyme inhibitor (ACEI) at referral. Many patients are referred late for dialysis despite early signs of renal failure, and the pre-referral management of many of the patients, as evidenced by the treatment of hypertension and use of ACEI in diabetics, is less than optimal.