Late referral and associated factors among chronic kidney disease outpatients in Southern Nigeria

• Published in: Annals of African medicine 2020-01, Vol.19 (1), p.47-52
• Main Authors: Okaka, Enajite, Adejumo, Oluseyi, Akinbodewa, Ayodeji
• Format: Article
• Language: English
• Subjects: Anemia; Blood transfusions; Chronic kidney failure; Diabetes; Diseases; Drug stores; Education; Gender; Hemodialysis; Hypertension; Kidney diseases; Medical referrals; Medical research; Morbidity; Mortality; Nephrology; Original; Outpatient care facilities; Physicians; Variables
• ISSN: 1596-3519; 0975-5764
• DOI: 10.4103/aam.aam_26_19

Background: Chronic kidney disease (CKD) is a recognized noncommunicable disease that contributes to the global disease burden. Studies on late referral (LR) of CKD patients to the nephrologist have reported incidence rates of 22%-58% according to the definition of LR used. CKD patients who present late to the nephrologist tend to have poorer outcomes with increased morbidity and mortality. Aim: The aim of the study is to determine the prevalence of LR and associated factors among CKD outpatients. Materials and Methods: A cross-sectional observational study, in which CKD patients attending the renal outpatient clinic of two tertiary hospitals over a period of 6 months, were recruited. LR was defined as commencement of renal replacement therapy within 3 months after the first presentation to a nephrologist. Results: A total of 181 participants were recruited during the period of study; 114 were men. One hundred and twelve participants (61.8%) had stage 5 CKD, of which 97 had commenced maintenance hemodialysis. The prevalence of LR was 44.8% (81/181) (95% confidence interval: 37.4%-51.9%). Lack of funds was the most frequent reason given by participants who delayed after formal referral to a nephrologist. Being a known diabetic was associated with LR. Age, gender, level of education, occupation, being a known hypertensive, or known diabetic were not significant predictors of LR. Conclusion: Prevalence of LR is high. Education of medical practitioners, patients, and the general public on early symptoms and physical signs of kidney disease is required. Initiation of all-encompassing health insurance scheme is necessary to solve the problem of lack of funds for medical consultation and treatment.