Prevalence, predictors, and consequences of late nephrology referral at a tertiary care center

Despite improvements in dialysis care, mortality of patients with end-stage renal disease (ESRD) remains high. One factor that has thus far received little attention, but might contribute to morbidity and mortality, is the timing of referral to the nephrologist. This study examines the hypothesis th...

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Bibliographic Details
Published in:	Journal of the American Society of Nephrology 1999-06, Vol.10 (6), p.1281-1286
Main Authors:	ARORA, P, OBRADOR, G. T, RUTHAZER, R, KAUSZ, A. T, MEYER, K. B, JENULESON, C. S, PEREIRA, B. J. G
Format:	Article
Language:	eng
Subjects:	Adult Aged Biological and medical sciences Boston - epidemiology Data Collection Evaluation Studies as Topic Female Hemodialysis Units, Hospital - standards Hemodialysis Units, Hospital - statistics & numerical data Humans Kidney Failure, Chronic - mortality Kidney Failure, Chronic - therapy Male Medical sciences Middle Aged Nephrology - statistics & numerical data Nephrology. Urinary tract diseases Nephropathies. Renovascular diseases. Renal failure Outcome Assessment, Health Care Predictive Value of Tests Referral and Consultation - standards Referral and Consultation - statistics & numerical data Renal Dialysis - standards Renal Dialysis - statistics & numerical data Renal failure Risk Assessment Survival Rate Time Factors
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Summary:	Despite improvements in dialysis care, mortality of patients with end-stage renal disease (ESRD) remains high. One factor that has thus far received little attention, but might contribute to morbidity and mortality, is the timing of referral to the nephrologist. This study examines the hypothesis that late referral of patients to the nephrologist might lead to suboptimal pre-ESRD care. Clinical and laboratory data were obtained from the patient records and electronic databases of New England Medical Center, its affiliated dialysis unit (Dialysis Clinics, Inc., Boston), and the office records of the outpatient nephrology clinic. Early (ER) and late (LR) referral were defined by the time of first nephrology encounter greater than or less than 4 mo, respectively, before initiation of dialysis. Multivariate models were built to explore factors associated with LR, and whether LR is associated with hypoalbuminemia or late initiation of dialysis. Of the 135 patients, 30 (22%) were referred late. There were no differences in age, gender, race, and cause of ESRD between ER and LR patients. However, there were significant differences in insurance coverage between these two groups. In the multivariate analysis, patients covered by health maintenance organizations were more likely to be referred late (odds ratio = 4.5) than patients covered by Medicare. Compared to ER, LR patients were more likely to have hypoalbuminemia (56% versus 80%), hematocrit
ISSN:	1046-6673 1533-3450