• L G Gøransson and H Bergrem.
• Division of Nephrology, Department of Medicine, Central Hospital of Rogaland, Stavanger, Norway. lasse.goransson@c2i.net
• J. Intern. Med. 2001 Aug 1;250(2):154-9.

ObjectivesThe aim of the present retrospective single centre study of patients entering renal replacement therapy (RRT), was to evaluate the effects of different referral patterns on morbidity, choice of therapy, and duration of hospitalization in patients with chronic renal failure.SubjectsA total of 242 patients with chronic renal failure starting their first RRT between 1984 and 1998, were divided into three groups. Group 1 (n=80): RRT started 1984-88, group 2 (n=73): RRT started 1989-93 and group 3 (n=89): RRT started 1994-98. Patients were classified as early referrals (ER) or late referrals (LR) depending on whether they started first RRT more than or less than 3 months after first referral to a nephrologist.ResultsThe proportion of LR was 27.3% (21 patients) in group 1, 27.4% (20 patients) in group 2 and 28.1% (25 patients) in group 3. In the ER, 35 patients (14.5%) received a predialytic kidney transplant, none in the LR. Comparing clinical details, the LR's in group 3 were significantly older than ER [median age 72 (53-81) vs. 56 (15-81) years, P < 0.0001], had a lower serum-albumin [median 33.0 (19.0-42.0) vs. 39 (19.0-48.0) g L-1, P < 0.0001], and serum-calcium [median 2.0 (1.4-2.6) vs. 2.3 (1.8-2.7) mmol L-1, P < 0.0001]. The ER had a significantly higher use of antihypertensive drugs, calcitriol, phosphate binders, and bicarbonate. Of the patients starting RRT on haemodialysis, all LR started on a temporary vascular access. About 43% of the ER started on a functioning arteriovenous fistula (P < 0.0001). The duration of hospital stay in connection with start of dialysis was 31 days (7-73) in the LR as compared with 7 (1-59) days in the ER (P < 0.0001).ConclusionsWe conclude that in our centre, early referral to nephrologist is associated with lower age, a higher likelihood of predialytic transplantation, better metabolic status at start of RRT, a higher proportion starting haemodialysis on a functioning arteriovenous fistula, and a shorter duration of the initial hospital stay. Further research on health care delivery is warranted.

30 keywords...

hide…