How does late nephrological co-management impact chronic kidney disease? - an observational study

Area of Science:

• Nephrology
• Public Health
• Internal Medicine

Background:

• Chronic kidney disease (CKD) management requires timely nephrological co-management.
• Late referral (LR) for CKD care may negatively impact patient outcomes.
• Understanding factors associated with mortality in LR is crucial for improving patient survival.

Purpose of the Study:

• To evaluate the impact of LR versus early referral (ER) on morbidity and mortality in CKD patients.
• To identify factors contributing to higher mortality in LR, accounting for lead-time and immortal time bias.

Main Methods:

• Retrospective observational study comparing 46 LR patients with 103 ER patients.
• Assessed CKD management quality based on guideline adherence for progression, complications, and cardiovascular risk factors.
• Analyzed one-year mortality and associated factors, adjusting for baseline glomerular filtration rate (GFR) to correct for biases.

Main Results:

• LR patients exhibited poorer control of CKD progression and cardiovascular risk factors, including glycemic control and use of specific medications.
• One-year mortality was significantly higher in the LR group (RR 5.9).
• Inadequate control of blood pressure, anemia, volume status, malnutrition, and emergency initial dialysis were independently linked to mortality, not LR itself.

Conclusions:

• LR is linked to substantially lower survival and inferior risk factor control in CKD patients, even after bias correction.
• Effective management of blood pressure, anemia, nutritional, and volume status, along with avoiding emergency dialysis, are key determinants of survival in CKD.