The Impact of Timing of Nephrology Referral on Prognosis in Patients with Diabetic Chronic Kidney Disease.
- Author:
Dong Young LEE
1
;
So Young CHOI
;
Sung Yeon CHO
;
Ji Young PARK
;
Sang Ho LEE
;
Chun Gyoo IHM
;
Tae Won LEE
Author Information
1. Division of Nephrology, Department of Internal Medicine, School of Medicine, Kyung Hee University, Korea. wonkid@chollian.net
- Publication Type:Original Article
- Keywords:
Diabetic nephropathy;
Referral;
Dialysis
- MeSH:
Cholesterol;
Diabetic Nephropathies;
Dialysis;
Heart Failure;
Humans;
Logistic Models;
Nephrology;
Prognosis;
Pulmonary Edema;
Referral and Consultation;
Renal Insufficiency, Chronic;
Renal Replacement Therapy;
Retrospective Studies;
Risk Factors
- From:Korean Journal of Nephrology
2009;28(4):286-294
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
PURPOSE: Diabetic patients with chronic kidney disease (CKD) are associated with a significantly poorer prognosis following renal replacement therapy (RRT) in comparison to those with nondiabetic CKD. To improve such prognosis, it is crucial to achieve a timely referral to nephrologists. This article evaluated the impact the timing of nephrology referral has on prognosis in patients with diabetic CKD. METHODS: Retrospective study was conducted regarding 239 patients with diabetic CKD on RRT. Patients were grouped according to referral patterns with those referred more than 1 month prior to initiating dialysis designated as early referral (ER) group and those referred within 1 month as late referral (LR) group. Characteristics of patients and risk factors for 3-month and 1-year mortality were analyzed, and mortality rates of ER and LR groups were compared using Kaplan-Meier curves of 1- year mortality. RESULTS: LR group showed a significantly higher (p=0.023) 1-year mortality rate and more frequently required urgent dialysis or angiocatheter and complicated congestive heart failure (CHF), pulmonary edema. Contrarily, ER group showed a significantly lower mortality rate (p=0.0179) based on Kaplan- Meier survival curve of 1-year mortality. According to logistic regression analysis, CVD (OR=7.695) and low total cholesterol level (OR=0.979) and CVD (OR=8.021), emergent dialysis (OR=3.734), and high HbA1C level (OR=1.528) were risk factors of significance of 3-month and 1-year mortality, respectively. CONCLUSION: Among diabetic patients with CKD, late-referred group was associated with a significantly higher rate of 1-year mortality. With LR as a risk factor of 1-year mortality according to univariate analysis, timing of referral is a critical prognostic factor.
