Timing of Nephrology Referral: Influence on Mortality and Morbidity in Chronic Kidney Disease

Abstract

BackgroundFew studies in India as well as in most developing countries have compared the mortality and morbidity rates between chronic kidney disease patients who were referred early to nephrologists and those who were referred late.ObjectivesTo study the mortality and morbidity patterns and to compare the various clinical parameters between the abovementioned early and late referrals.Patients and MethodsFifty consecutive chronic kidney disease patients were followed up for one year. They were then classified as early referral (patients who underwent dialysis more than three months after the referral) and late referral (patients who underwent dialysis within three months of the referral). Clinical, laboratory parameters, and mortality patterns were compared between the two groups.ResultsThe blood pressure, hemoglobin, glomerular filtration rate, and calcium and phosphate values were better in the early referral group. Among the 24 complications that occurred, 17 (70.8%) were seen among the patients who were referred late. Among the 13 deaths that occurred, only one belonged to the early referral group.ConclusionsWe observed that the mortality rate and clinical parameters were better in patients who were referred early to nephrologists.

Nephrology pre‐dialysis care affects the psychological adjustment, not only blood pressure, anemia, and phosphorus control

“…It is well known that early referral is associated with good clinical outcomes, reduced mortality and hospitalization, and patients had better dialysis preparation . Our present study also suggested that blood pressure, serum phosphorous, and anemia were managed significantly better in early referral compared with late referral.…”

“…It is well known that early referral is associated with good clinical outcomes, reduced mortality and hospitalization, and patients had better dialysis preparation. [1][2][3][4][5] Our present study also suggested that blood pressure, serum phosphorous, and anemia were managed significantly better in early referral compared with late referral. The outcomes of previous studies were focused on mortality, hospitalization, blood pressure, biochemical parameters (serum calcium and phosphorous, hemoglobin, lipid profile, serum albumin), use of erythropoietin, and prevalence of other comorbid diseases (diabetes, cardiovascular disease, heart failure, stroke, chronic obstructive pulmonary disease), but rarely on the psychological factors.…”

“…Morbidity and mortality of patients with chronic kidney disease remains high despite advances in technology and improvements in care. Several studies have suggested that pre‐dialysis care is associated with clinical outcomes . However, little has been reported on the influence of pre‐dialysis care on the psychological adjustment to dialysis.…”

“…Several studies have suggested that pre-dialysis care is associated with clinical outcomes. [1][2][3][4][5] However, little has been reported on the influence of pre-dialysis care on the psychological adjustment to dialysis. Increasing evidence implicated that psychological factors were important both because they had an impact on quality of life and had been shown to influence the progression of various chronic diseases.…”

Effects of Early Frequent Nephrology Care on Emergency Department Visits among Patients with End-stage Renal Disease

“…Early referral can help to slow the progression to ESRD and diminished renal function [5,6]. It has also been associated with reduced healthcare costs [7], reduced risk of cardiovascular events [8], reduced risk of early technique failure [9], and lower hospitalization and mortality rates [5,10,11,12,13,14]. Patients who receive an early referral tend to enjoy more quality-adjusted life-years (QALYs) [15], superior placement of dialysis access [12,16], and greater freedom in the selection of dialysis modality [17].…”