Early referral to nephrologist is required for improving outcome
of chronic kidney disease patients
Mohamed F.T. Almaghraby
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 outcom |
