First referral of diabetic patients to a nephrologist

Late Referral of Patients With Chronic Kidney Disease: No Time to Waste

“…43 Substantial differences in referral patterns exist among different specialists: nephrologists like to see diabetic patients as soon as microalbuminuria is detected, whereas endocrinologists do not consider this a good reason for referral and usually refer only when an increased serum creatinine level is noted. [44][45][46] A Canadian study showed that many first-line general practitioners appreciate receiving feedback and guidelines from nephrologists. 43 Also, problems related to nephrologists and their practices must be considered, such as long waiting lists for consultation, lack of time for sufficient patient counseling, and lack of communication and coordination of care with first-line general practitioners.…”

Factors influencing general practitioner referral of patients developing end-stage renal failure: a standardised case-analysis study

“…For example, the guidelines of the UK Renal Association [ 9 ] indicate that all patients with a creatinine between 150–200 mmol/L should be referred to a specialist. Similarly, a European study investigating the optimal time for a first referral to a nephrologist found substantial differences between diabetes experts and nephrologists [ 10 ].…”

The European Association for the Study of Diabetes

“…He reviewed a group of studies, showing that referral to the nephrologist Ͻ4 months before dialysis is needed is associated with 1.2-to 7.7-fold higher mortality. A National Institutes of Health consensus conference in 1994 suggested referral at a serum creatinine of 2 mg/dl, with most nephrologists suggesting a level of 2-3 mg/dl (17). Noting the International Diabetes Federation guideline of creatinine 2.5-3.5 mg/dl, Bergrem commented that "as a nephrologist I would say this is a late referral.…”