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Late referral defined by renal function: association with morbidity and mortality
Karl Lhotta1, Michael Zoebl, Gert Mayer
1Division of Nephrology, Department of Internal Medicine, Innsbruck University Hospital, Innsbruck, Austria. Karl.Lhotta@uibk.ac.at
Journal of Nephrology
|January 23, 2004
Summary
Late referral to nephrology units in chronic renal failure patients is common. While late referral may increase mortality, comorbidity is the primary driver of death within two years of renal replacement therapy.
Area of Science:
- Nephrology
- Public Health
Background:
- Many patients with chronic renal failure (CRF) are referred late to nephrology units.
- Late referral (LR) is associated with increased morbidity and mortality.
Purpose of the Study:
- To investigate the impact of early referral (ER) versus late referral (LR) on mortality in patients with chronic renal failure.
- To identify factors influencing mortality in patients undergoing renal replacement therapy (RRT).
Main Methods:
- Retrospective analysis of 75 patients with CRF starting RRT between 1999 and 2000.
- Patients classified as ER or LR based on initial glomerular filtration rate (GFR).
- Survival analysis using Cox's proportional hazard model and comorbidity scoring.
Main Results:
- Over half of patients (42/75) were classified as LR (GFR < 20 mL/min/1.73 m2).
- LR patients had higher rates of diabetic nephropathy and comorbidity.
- Comorbidity score, not LR, was significantly associated with mortality within two years of RRT.
Conclusions:
- Late referral is prevalent in end-stage renal disease (ESRD) patients.
- Comorbidity significantly impacts mortality during the initial two years of RRT.
- The negative impact of late referral on mortality requires further investigation with larger sample sizes.