• Farid Samaan, Danilo Euclides Fernandes, Gianna Mastroianni Kirsztajn, and Ricardo Sesso.
• MD, PhD. Nephrology Project Manager, Municipal Health Department of Santana de Parnaíba, Santana de Parnaíba (SP), Brazil; National Nephrology Coordinator, Grupo NotreDame Intermédica, São Paulo (SP), Brazil; Former Nephrology Coordinator, Hospital Leforte, São Paulo (SP), Brazil; and Postdoctoral Researcher, Department of Medicine, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil.
• Sao Paulo Med J. 2022 May 1; 140 (3): 366371366-371.

BackgroundThe number of nephrologists has risen slowly, compared with the prevalence of chronic kidney disease (CKD) in Brazil. Data on patients referred to nephrology outpatient clinics remains scarce.ObjectiveTo determine the demographic and kidney function characteristics of patients at their first appointment with a nephrologist.Design And SettingRetrospective study conducted at three nephrology outpatient clinics (public and private services), in São Paulo, Brazil.MethodsFrom December 2019 to February 2020, we collected patient data regarding demographics, kidney function parameters and comorbidities. We then analyzed data on 394 patients who met a nephrologist for their first appointment.ResultsThe main comorbidities were hypertension (63.7%), diabetes (33.5%) and nephrolithiasis (22.3%). Regarding CKD stages, 24.1%, 9.1%, 13.7%, 15.2%, 15.2% and 2.3% of the patients were in stages 1, 2, 3a, 3b, 4 and 5, respectively. Proteinuria was absent or mild, moderate and high in 17.3%, 15.2% and 11.7%, respectively; and 16.2% had not undergone previous investigation of serum creatinine or proteinuria (55.8%). For 17.5%, referral to a nephrologist occurred late. Patients in public services were older than those in private services (59 years versus 51 years, respectively; P = 0.001), more frequently hypertensive (69.7% versus 57.5%; P = 0.01) and reached a nephrologist later (22.4% versus 12.4%; P = 0.009).ConclusionReferrals to a nephrologist were not being made using any guidelines for CKD risk and many cases could have been managed within primary care. Late referral to a nephrologist happened in one-fifth of the cases and more frequently in the public service.

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