Late referral of end-stage renal failure

QJM. 1998 Nov;91(11):727-32. doi: 10.1093/qjmed/91.11.727.

Abstract

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.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Antihypertensive Agents / therapeutic use
  • Cohort Studies
  • Creatinine / blood
  • Female
  • Hospitalization
  • Humans
  • Hypertension / drug therapy
  • Kidney Failure, Chronic / blood
  • Kidney Failure, Chronic / etiology
  • Kidney Failure, Chronic / therapy*
  • Male
  • Middle Aged
  • Referral and Consultation / statistics & numerical data
  • Renal Dialysis
  • Renal Replacement Therapy / statistics & numerical data*
  • Time Factors
  • Treatment Outcome

Substances

  • Antihypertensive Agents
  • Creatinine