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[Influence of early or late referral to nephrologist over morbidity and mortality in hemodialysis].
Nefrologia. 2003; 23(3):234-42.N

Abstract

OBJECTIVE

We studied the influence of early vs late referral to nephrologist of patients with chronic renal failure over clinical situation at the onset of hemodialysis and outcome.

SUBJECTS AND METHODS

From january 1994 to december 1998, 139 patients started hemodialysis for end-stage renal disease at the Hospital General de Albacete, all of them included in the study and clinical follow-up concluded in december 2001. Patients with rapidly progressive glomerulonephritis were excluded. Early (ER) and late referral (LR) were defined by the time of first nephrology encounter greater than or less than 6 months respectively, before iniciation of hemodialysis.

RESULTS

106 patients (76.25%) were referred early; mean follow-up time 6.3 +/- 4.5 years. 33 patients (23.74%) had late referral, follow-up time was less then six months, 18 patients were followed during less than 4 weeks. There were no differences in demographic data and comorbid conditions between LR and ER patients (age, cardiac and vascular disease, diabetes, neoplasia...). Mean plasma concentration of creatinine and urea was significantly greater, whereas hematocrit and albumin were less in the LRA than the ER group. Emergency dialysis through central vein catheterisation was more frequent in the LR group. Number of admissions and duration of hospital stay were higher in the LR group. No significant differences in nutrition, dialysis doses or anemia were found between the two groups after 6 and 12 months of hemodialysis. Long term outcome was similar in both groups: no significant differences were found in percentage of patients transplanted or deceased after 3 years of treatment. Survival analysis failed to show a difference between ER and LR groups (mean survival time was 73.6 +/- 4.3 months and 73.0 +/- 6 months respectively).

CONCLUSION

Late referral to the nephrologist is associated with increased early morbidity vs early referral, although long term outcome is not worse if predialysis comorbid conditions are comparable and dialysis care achieve equal results in dialysis doses, nutrition and anemia in both groups in the first months of treatment. Improvement of outcome of patients referred early to the nephrologist will depend on the adoption of preventive measures over comorbidity factors that should be applied in early stages of renal disease.

Authors+Show Affiliations

Servicio de Nefrología, Hospital General Universitario de Albacete, Hermanos Falcó, s/n 02002 Albacete. eduardogallego@ono.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
English Abstract
Journal Article

Language

spa

PubMed ID

12891938

Citation

Gallego, E, et al. "[Influence of Early or Late Referral to Nephrologist Over Morbidity and Mortality in Hemodialysis]." Nefrologia : Publicacion Oficial De La Sociedad Espanola Nefrologia, vol. 23, no. 3, 2003, pp. 234-42.
Gallego E, López A, Lorenzo I, et al. [Influence of early or late referral to nephrologist over morbidity and mortality in hemodialysis]. Nefrologia. 2003;23(3):234-42.
Gallego, E., López, A., Lorenzo, I., López, E., Llamas, F., Illescas, M. L., Andrés, E., Serrano, A., Olivas, E., & Gómez Roldán, C. (2003). [Influence of early or late referral to nephrologist over morbidity and mortality in hemodialysis]. Nefrologia : Publicacion Oficial De La Sociedad Espanola Nefrologia, 23(3), 234-42.
Gallego E, et al. [Influence of Early or Late Referral to Nephrologist Over Morbidity and Mortality in Hemodialysis]. Nefrologia. 2003;23(3):234-42. PubMed PMID: 12891938.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Influence of early or late referral to nephrologist over morbidity and mortality in hemodialysis]. AU - Gallego,E, AU - López,A, AU - Lorenzo,I, AU - López,E, AU - Llamas,F, AU - Illescas,M L, AU - Andrés,E, AU - Serrano,A, AU - Olivas,E, AU - Gómez Roldán,C, PY - 2003/8/2/pubmed PY - 2003/10/2/medline PY - 2003/8/2/entrez SP - 234 EP - 42 JF - Nefrologia : publicacion oficial de la Sociedad Espanola Nefrologia JO - Nefrologia VL - 23 IS - 3 N2 - OBJECTIVE: We studied the influence of early vs late referral to nephrologist of patients with chronic renal failure over clinical situation at the onset of hemodialysis and outcome. SUBJECTS AND METHODS: From january 1994 to december 1998, 139 patients started hemodialysis for end-stage renal disease at the Hospital General de Albacete, all of them included in the study and clinical follow-up concluded in december 2001. Patients with rapidly progressive glomerulonephritis were excluded. Early (ER) and late referral (LR) were defined by the time of first nephrology encounter greater than or less than 6 months respectively, before iniciation of hemodialysis. RESULTS: 106 patients (76.25%) were referred early; mean follow-up time 6.3 +/- 4.5 years. 33 patients (23.74%) had late referral, follow-up time was less then six months, 18 patients were followed during less than 4 weeks. There were no differences in demographic data and comorbid conditions between LR and ER patients (age, cardiac and vascular disease, diabetes, neoplasia...). Mean plasma concentration of creatinine and urea was significantly greater, whereas hematocrit and albumin were less in the LRA than the ER group. Emergency dialysis through central vein catheterisation was more frequent in the LR group. Number of admissions and duration of hospital stay were higher in the LR group. No significant differences in nutrition, dialysis doses or anemia were found between the two groups after 6 and 12 months of hemodialysis. Long term outcome was similar in both groups: no significant differences were found in percentage of patients transplanted or deceased after 3 years of treatment. Survival analysis failed to show a difference between ER and LR groups (mean survival time was 73.6 +/- 4.3 months and 73.0 +/- 6 months respectively). CONCLUSION: Late referral to the nephrologist is associated with increased early morbidity vs early referral, although long term outcome is not worse if predialysis comorbid conditions are comparable and dialysis care achieve equal results in dialysis doses, nutrition and anemia in both groups in the first months of treatment. Improvement of outcome of patients referred early to the nephrologist will depend on the adoption of preventive measures over comorbidity factors that should be applied in early stages of renal disease. SN - 0211-6995 UR - https://www.unboundmedicine.com/medline/citation/12891938/[Influence_of_early_or_late_referral_to_nephrologist_over_morbidity_and_mortality_in_hemodialysis]_ L2 - http://www.revistanefrologia.com/es/linksolver/ft/ivp/0211-6995/23/234 DB - PRIME DP - Unbound Medicine ER -