Patients' Referral Pattern and Dialysis Initiation Practice: Single Center Experience.
- Author:
Hyun Jin NOH
;
Suk Kyun SHIN
;
Hyun Yong SONG
;
Jae Ha HWANG
;
Shin Wook KANG
;
Kyu Heon CHOI
;
Dae Seok HAN
;
Ho Young LEE
;
Ru Tha LEE
;
Hyun Jung ROH
;
Dong Ryeol RYU
;
Tae Hyun YOO
;
Sung Kyu HA
- Publication Type:Original Article
- MeSH:
Arterial Pressure;
Blood Pressure;
Dialysis*;
Female;
Humans;
Mortality;
Nephrology;
Referral and Consultation*;
Renal Replacement Therapy;
Retrospective Studies
- From:Korean Journal of Nephrology
1999;18(6):965-973
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
Despite improvements in dialysis care, the mortality of patients with end-stage renal disease(ESRD) remains high. One factor that has so far received little attention, but which might contribute to morbidity and mortality, is the timing of referral to the nephrologist. We performed a retrospective analysis in 358 patients(male 275, female 151) who were initiated renal replacement therapy first at this hospital from Jan 1995 to Dec 1996. Patients were defined by the time of first nephrology as early referral(E, n=163) encountered after more than 8 weeks; late early referral(LE, n=19) encountered between 8 weeks and 4 weeks; late referral(L, n=55) encountered from 1 week to 4 weeks; urgent referral(U, n= 121) encountered less than 1 week. There were no differences in age, gender, primary renal disease, cause of dialysis, and renal replacement therapy modalities. However, there were significant differences in rnean arterial pressure and serum phosphate levels between these 4 groups. The mean arterial pressures (mmHg) were 109.15 +/- 17.16, 105.37+/-18.76, 117.24 +/- 27.24 and 116.98+/-24.26 for E, LE, L and U, respectively(p<0.05, compared E to U). In the U group, serum phosphate levels were elevated at initiation of dialysis compared to the E group(6.39+/-1.72 vs 7.29 +/- 3.54mg/dL, p<0.05). One year mortality in the U group had on increased tendency compared to the E group, especially earlier mortality(7.4% vs 14.9N, p>0.05). In the E group, there was more controlled blood pressure and serum phosphate levels compared to the U group at initiation of renal replacement therapy, but other parameters were not significantly different among the 4 groups. Delays in initiation of renal replacement therapy may result in patients entering dialysis in a compromised state, therefore adequate long-term predialysis care by a nephrologist is important. Socioeconomic - and medical factors respon-sible for late referral and late initiation of dialysis need to be evaluated and corrected to further improve the outcome of these patients.
