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Published on: June 16, 2014
The first appointment with a nephrologist: Brazilian patients' demographic and kidney function characteristics. A
Farid Samaan1, Danilo Euclides Fernandes2, Gianna Mastroianni Kirsztajn3
1MD, PhD. Nephrology Project Manager, Municipal Health Department of Santana de Parnaíba, Santana de Parnaíba (SP), Brazil; National Nephrology Coordinator, Grupo NotreDame Intermédica, São Paulo (SP), Brazil; Former Nephrology Coordinator, Hospital Leforte, São Paulo (SP), Brazil; and Postdoctoral Researcher, Department of Medicine, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil.
Insights
Many patients with chronic kidney disease (CKD) see a nephrologist late, often without clear referral guidelines. This study analyzed patient characteristics at their first nephrology appointment in Brazil.
Area of Science:
- Nephrology
- Public Health
- Epidemiology
Background:
- The prevalence of chronic kidney disease (CKD) in Brazil is rising, yet the number of nephrologists has not kept pace.
- Data regarding patients referred to nephrology outpatient clinics is limited, hindering effective healthcare planning.
Purpose of the Study:
- To characterize the demographic and kidney function profiles of patients during their initial consultation with a nephrologist.
- To identify patterns in patient referrals and comorbidities within nephrology outpatient settings.
Main Methods:
- A retrospective study was conducted across three nephrology outpatient clinics in São Paulo, Brazil.
- Data from 394 patients attending their first nephrologist appointment between December 2019 and February 2020 were analyzed.
- Patient demographics, kidney function parameters (serum creatinine, proteinuria), and comorbidities were collected and examined.
Main Results:
- Hypertension (63.7%), diabetes (33.5%), and nephrolithiasis (22.3%) were the most common comorbidities.
- A significant proportion of patients presented with advanced CKD stages (Stage 3b or higher: 32.7%).
- Late referral to a nephrologist occurred in 17.5% of cases, with higher rates observed in public healthcare services.
Conclusions:
- Nephrologist referrals often lack adherence to established CKD risk guidelines, suggesting many cases could be managed in primary care.
- Late referrals, particularly in public services, indicate a need for improved CKD screening and referral protocols.
- The findings highlight a gap in timely and guideline-directed nephrology care in Brazil.
Background:
The number of nephrologists has risen slowly, compared with the prevalence of chronic kidney disease (CKD) in Brazil. Data on patients referred to nephrology outpatient clinics remains scarce.
Objective:
To determine the demographic and kidney function characteristics of patients at their first appointment with a nephrologist.
Design And Setting:
Retrospective study conducted at three nephrology outpatient clinics (public and private services), in São Paulo, Brazil.
Methods:
From December 2019 to February 2020, we collected patient data regarding demographics, kidney function parameters and comorbidities. We then analyzed data on 394 patients who met a nephrologist for their first appointment.
Results:
The main comorbidities were hypertension (63.7%), diabetes (33.5%) and nephrolithiasis (22.3%). Regarding CKD stages, 24.1%, 9.1%, 13.7%, 15.2%, 15.2% and 2.3% of the patients were in stages 1, 2, 3a, 3b, 4 and 5, respectively. Proteinuria was absent or mild, moderate and high in 17.3%, 15.2% and 11.7%, respectively; and 16.2% had not undergone previous investigation of serum creatinine or proteinuria (55.8%). For 17.5%, referral to a nephrologist occurred late. Patients in public services were older than those in private services (59 years versus 51 years, respectively; P = 0.001), more frequently hypertensive (69.7% versus 57.5%; P = 0.01) and reached a nephrologist later (22.4% versus 12.4%; P = 0.009).
Conclusion:
Referrals to a nephrologist were not being made using any guidelines for CKD risk and many cases could have been managed within primary care. Late referral to a nephrologist happened in one-fifth of the cases and more frequently in the public service.
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