Consequences of late referral in diabetic renal disease

The incidence of patients with end-stage renal disease and type 2 diabetes has increased tremendously over the past few decades. Unfortunately, many patients with diabetes are referred late to nephrologists. Currently, between a quarter and a third of European patients are referred to a nephrologist less than one month prior to the initiation of renal replacement therapy. The causes of late referral can be categorised into physician-related factors, patient-related factors, and factors related to the disease itself, such as the lack of a good general indicator of renal function. The consequences of late referral include poorer status upon referral, higher rates of hospitalisation and higher costs, and even increased mortality. Several interventions can be undertaken to improve the referral of patients with renal disease and diabetes, including improved medical education, better communication between GPs and nephrologists, adoption of a team approach between nephrologists, diabetologists and GPs, improved patient information, development of guidelines, and financial incentives to encourage earlier referral of these patients.