Original InvestigationTiming of nephrology referral: Influence on mortality and morbidity*,**
Section snippets
Patients and methods
We retrospectively studied the medical records of 309 patients with end-stage renal failure who entered the hemodialysis program in Sainte-Marguerite University Hospital (Marseille, France) for the first time between January 1, 1989, and December 31, 1996. Information on the timing of nephrology referral before dialysis was available for 304 patients and was used to assign patients to two groups. Patients were considered early referral (ER) if they were referred to a nephrologist at least 16
Clinical characteristics of patients
Among the 270 patients who entered onto the study, 177 patients (66%) were referred early, at a mean of 244 ± 277 weeks (4.7 ± 5.3 years) before the start of dialysis (range, 16 weeks to 31 years; median, 142 weeks), and 93 patients (34%) were referred late, at a mean of 1.75 ± 2.7 weeks before the start of dialysis (range, 0 to 13 weeks; median, 0 weeks). The rate of patients referred late was the same (30%) in 1989 and 1996. Table 1 shows the demographic characteristics of patients and
Discussion
Late nephrology referral is a common problem and is frequently associated with greater initial morbidity or mortality.1, 16 The aim of our study is to assess the influence of the timing of nephrology referral on long-term morbidity and mortality in our hemodialysis population.
Initial complications were strikingly greater in patients with a late nephrology referral. The need for initial emergent dialysis and temporary central venous catheterization and uremia-related complications, such as
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Received May 17, 1999; accepted in revised form February 25, 2000.
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Address reprint requests to Yvon Berland, MD, Service de Néphrologie et Hémodialyse, Hôpital Sainte Marguerite, 270 Boulevard de Sainte Marguerite, 13009 Marseille, France. E-mail: [email protected]