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Original Paper

Referral to Nephrologists for Chronic Kidney Disease Care: Is Non-Diabetic Kidney Disease Ignored?

Navaneethan S.D.a · Nigwekar S.b · Sengodan M.c · Anand E.b · Kadam S.b · Jeevanantham V.c · Grieff M.b · Choudhry W.c

Author affiliations

aDivision of Nephrology, University of Rochester, bDepartment of Medicine and Nephrology, Rochester General Hospital, and cDepartment of Medicine and Nephrology, Unity Health System, Rochester, N.Y., USA

Related Articles for ""

Nephron Clin Pract 2007;106:c113–c118

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Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: September 12, 2006
Accepted: February 02, 2007
Published online: May 22, 2007
Issue release date: July 2007

Number of Print Pages: 1
Number of Figures: 0
Number of Tables: 4


eISSN: 1660-2110 (Online)

For additional information: http://www.karger.com/NEC

Abstract

Background: Late referral to nephrologists is common and associated with increased morbidity and mortality. We aimed to analyze the prevalence rates, predictors and consequences of late referral to nephrologists by primary care physicians for chronic kidney disease (CKD) care. Methods: A retrospective analysis of 204 patients started on dialysis for CKD in two community hospitals between March 2003 and March 2005 was conducted. Relevant clinical and laboratory data were obtained from the patient records of the nephrology clinics and dialysis units. Patients referred in CKD stage 5 (estimated glomerular filtration rate <15 ml/min) were defined as late referral and patients in CKD stage 1–4 (estimated glomerular filtration rate >15 ml/min) as early referral. Results: Forty-five (22%) of the 204 patients were referred late. In the multivariate analysis, non-diabetic kidney disease (odds ratio = 2.46, p = 0.02) and Charlson comorbidity index (odds ratio = 1.17, p = 0.009) were significantly associated with late referral. The late referral group had lower hematocrit and serum calcium levels, and higher serum phosphorus and parathyroid hormone levels than the early referral group (p ≤0.05) at the time of referral. Late referral resulted in less permanent vascular access for initiation of dialysis (p = 0.03). Even though there was twice the number of deaths in the late referral group in 1 year (18 vs. 9%), this was not statistically significant (p = 0.07). Conclusion: Referring physicians should pay special attention to patients with non-diabetic kidney disease and patients with multiple comorbidities since delayed referral to nephrologists may result in poorer patient-related outcomes. Larger and long-term prospective studies analyzing the long-term consequences of late referral to nephrologists are needed.

© 2007 S. Karger AG, Basel


Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: September 12, 2006
Accepted: February 02, 2007
Published online: May 22, 2007
Issue release date: July 2007

Number of Print Pages: 1
Number of Figures: 0
Number of Tables: 4


eISSN: 1660-2110 (Online)

For additional information: http://www.karger.com/NEC


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Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
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