Timing of referral of chronic kidney disease patients to nephrology services (adult)

Luxton, Grant

doi:10.1111/j.1440-1797.2010.01224.x

Cited by 18 publications

(20 citation statements)

References 66 publications

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“…[13][14][15][16][17] In fact, patients with an eGFR of 30 mL/min per 1.73 m 2 or less should be referred to a nephrologybased care for appropriate CKD education in order to allow adequate time (at least 3-6 months) for predialysis education. 18,19 This study showed that a program with a nephrologist-based MDC approach could improve clinical renal outcome and reduce medical cost, even for patients with advanced renal failure (eGFR < 15 mL/min per 1.73 m 2 ). Our study demonstrated that most of the stage 5 CKD patients who did not receive MDC underwent incident dialysis therapy with a catheter than those of the stage 5 CKD patients who received MDC.…”

Section: Discussionmentioning

confidence: 99%

Educational Intervention in CKD Retards Disease Progression and Reduces Medical Costs for Patients with Stage 5 CKD

Lei¹,

Lee²,

Hsu³

et al. 2012

Renal Failure

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Background: Nephrologist-based multidisciplinary care (MDC) has a positive impact on slowing chronic kidney disease (CKD) progression. However, the benefits of MDC in patients with stage 5 CKD remain unclear. Methods: Stage 5 CKD patients who visited the Chang Gung Memorial Hospital, Chiayi, Taiwan during the period of 2002-2008 were enrolled. The incident dialysis and medical cost were compared between MDC recipients and nonrecipients. The MDC recipients were divided into two groups by educational duration to observe the clinical renal outcome and medical care expenses. The effect of MDC on renal disease progression was also compared in MDC recipients with and without diabetes. Results: Out of 307 patients, 171 received MDC. For MDC recipients, the temporary usage of catheter was reduced (54.7% vs. 79.4%, p < 0.001), the hospital stay was shorter (18.64 AE 1.20 vs. 24.63 AE 1.22 months, p ¼ 0.001), and the total medical cost was lower [New Taiwan dollars (NTD) 105,948.54 AE 9,967.22 vs. NTD 160,388.61 AE 16,373.97, p ¼ 0.005] than for nonrecipients. Out of the 171 MDC recipients, those with MDC for more than 1 year had slower renal disease progression (0.76 AE 0.27 mL/min per 1.73 m 2 per year) and had an estimated per-capita annual cost savings of about NTD 336,500.66. MDC recipients with diabetes had a higher risk of requiring dialysis than those without diabetes. Conclusions: MDC could significantly reduce temporary use of the catheter, hospital stay, and total medical costs in patients with stage 5 CKD. Furthermore, longer (>1 year) MDC could preserve renal function and deliver annual medical cost savings.

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Section: Discussionmentioning

confidence: 99%

Educational Intervention in CKD Retards Disease Progression and Reduces Medical Costs for Patients with Stage 5 CKD

Lei¹,

Lee²,

Hsu³

et al. 2012

Renal Failure

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“…[18][19][20] In the Caring for Australasians With Renal Impairment guidelines, 21 it is recommended that patients with an estimated glomerular filtration rate (eGFR) Ͻ30 mL/min/1.73 m 2 (CKD stage 4) be referred to a nephrology service to give adequate time to prepare for RRT or supportive management and palliative care. 22 A retrospective study of patients with CKD stages 3 and 4 in the United States referred to a nephrology service compared with those who were stage 4 CKD and not referred found that elderly and female patients were less likely to be referred. 23 In addition, for elderly patients, greater comorbidity was a predictor of nonreferral.…”

Section: 17mentioning

confidence: 99%

Estimating the Total Incidence of Kidney Failure in Australia Including Individuals Who Are Not Treated by Dialysis or Transplantation

Sparke

Moon

Green

et al. 2013

American Journal of Kidney Diseases

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“…A pesar de eso, no existe un total consenso sobre cuál es el momento exacto para la referencia al nefrólogo. La mayoría concuerda que una TFG menor a 30 mL/min o la presencia de proteinuria son razones suficientes para la referencia (17) . Siguiendo estas consideraciones, gran porcentaje de nuestros pacientes aún no ha requerido una evaluación nefrológica propiamente dicha, lo que ha sido encontrado previamente como una consecuencia de la actual clasificación de la ERC basada en la TFG, donde existe un aumento de consulta nefrológica en situaciones en las que no es requerida (18) , lo cual es de particular importancia en un medio como el nuestro donde existe escasez de nefrólogos (19) .…”

Section: Discussionunclassified

Características clínicas de los pacientes diabéticos que acuden por primera vez a una consulta nefrológica en hospitales públicos de Lima

et al. 2014

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Introducción: La diabetes mellitus es la principal causa de enfermedad renal crónica y se recomienda una referencia temprana al nefrólogo, ya que se ha reportado peores resultados en pacientes con referencia tardía. Objetivos: Determinar las características de los pacientes diabéticos en su primera consulta nefrológica. Diseño: Estudio multicéntrico, observacional y analítico. Lugar: Hospital Nacional 2 de Mayo, Hospital Nacional Arzobispo Loayza, Hospital Daniel Alcides Carrión y Hospital María Auxiliadora. Participantes: Pacientes diabéticos. Intervenciones: Se estudió a los pacientes en su primera consulta nefrológica entre septiembre 2011 y febrero 2012. Para la descripción se utilizó porcentajes, frecuencias y desviaciones estándar. Principales medidas de resultados: Características clínicas de los pacientes diabéticos. Resultados: Se estudió 200 pacientes diabéticos, con tiempo de diagnóstico promedio de 12,9 años. El 73% recibió educación para autocuidados. El 40% refería que no tomaba sus medicamentos y 57% no seguía su dieta regularmente. El 70% era hipertenso con tiempo de diagnóstico promedio de 4,2 años; 36,5% era obeso, 52,8% sufría de dislipidemia, 10,5% tenía antecedente de enfermedad cardiovascular. El 81,5% refería no haber tenido una evaluación previa de la función renal. El 39,5% tenía hemoglobina glicosilada (HbA1c) >7%, 48,5% colesterol >200 mg/dL, 54,5% cLDL>100 mg/dL y 46,5% triglicéridos >150 mg/dL; 57% un tiempo de filtración glomerular<60 mL/min y 37% presentó albuminuria de 300 mg/d o más. Conclusiones: Casi la mitad de los pacientes no seguía las recomendaciones de autocuidados. Debido a los factores de riesgo cardiovascular involucrados en este grupo, se debería reforzar su educación.

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Timing of referral of chronic kidney disease patients to nephrology services (adult)

Abstract: Date written: July 2008 Final submission: February 2009

Cited by 18 publications

References 66 publications

Educational Intervention in CKD Retards Disease Progression and Reduces Medical Costs for Patients with Stage 5 CKD

Educational Intervention in CKD Retards Disease Progression and Reduces Medical Costs for Patients with Stage 5 CKD

Estimating the Total Incidence of Kidney Failure in Australia Including Individuals Who Are Not Treated by Dialysis or Transplantation

Características clínicas de los pacientes diabéticos que acuden por primera vez a una consulta nefrológica en hospitales públicos de Lima

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