title: Canadian survey of clinical status at dialysis initiation 1998-1999: a multicenter prospective survey.
abstract: OBJECTIVE
  The current growth in end-stage kidney disease populations has led to increased efforts to understand the impact of status at dialysis initiation on long-term outcomes. Our main objective was to improve the understanding of current Canadian nephrology practice between October 1998 and December 1999.
  
  
  METHODS
  Fifteen nephrology centers in 7 provinces participated in a prospective data collection survey. The main outcome of interest was the clinical status at dialysis initiation determined by: residual kidney function, preparedness for chronic dialysis as measured by presence or absence of permanent peritoneal or hemodialysis access, hemoglobin and serum albumin. Uremic symptoms at dialysis initiation were also recorded, however, in some cases these symptom data were obtained retrospectively.
  
  
  RESULTS
  Data on 251 patients during 1-month periods were collected. Patients commenced dialysis at mean calculated creatinine clearance levels of approximately 10 ml/min, with an average of 3 symptoms. 35% of patients starting dialysis had been known to nephrologists for less than 3 months. These patients are more likely to commence without permanent access and with lower hemoglobin and albumin levels. Even of those known to nephrologists, only 66% had permanent access in place.
  
  
  CONCLUSIONS
  Patients commencing dialysis in Canada appear to be doing so in relative concordance with published guidelines with respect to timing of initiation. Despite an increased awareness of kidney disease, a substantial number of patients continues to commence dialysis without previous care by a nephrologist. Of those who are seen by nephrologists, clinical and laboratory parameters are suboptimal according to current guidelines. This survey serves as an important baseline for future comparisons after the implementation of educational strategies for referring physicians and nephrologists.
authors.affiliation: Division of Nephrology, Memorial University of Newfoundland, Canada.
authors.forename: B M
authors.initials: BM
authors.lastname: Curtis
authors.forename: B J
authors.initials: BJ
authors.lastname: Barret
authors.forename: K
authors.initials: K
authors.lastname: Jindal
authors.forename: O
authors.initials: O
authors.lastname: Djurdjev
authors.forename: A
authors.initials: A
authors.lastname: Levin
authors.forename: P
authors.initials: P
authors.lastname: Barre
authors.forename: K
authors.initials: K
authors.lastname: Bernstein
authors.forename: P
authors.initials: P
authors.lastname: Blake
authors.forename: E
authors.initials: E
authors.lastname: Carlisle
authors.forename: P
authors.initials: P
authors.lastname: Cartier
authors.forename: C
authors.initials: C
authors.lastname: Clase
authors.forename: B
authors.initials: B
authors.lastname: Culleton
authors.forename: C
authors.initials: C
authors.lastname: Deziel
authors.forename: S
authors.initials: S
authors.lastname: Donnelly
authors.forename: J
authors.initials: J
authors.lastname: Ethier
authors.forename: A
authors.initials: A
authors.lastname: Fine
authors.forename: G
authors.initials: G
authors.lastname: Ganz
authors.forename: M
authors.initials: M
authors.lastname: Goldstein
authors.forename: J
authors.initials: J
authors.lastname: Kappel
authors.forename: G
authors.initials: G
authors.lastname: Karr
authors.forename: S
authors.initials: S
authors.lastname: Langlois
authors.forename: D
authors.initials: D
authors.lastname: Mendelssohn
authors.forename: N
authors.initials: N
authors.lastname: Muirhead
authors.forename: B
authors.initials: B
authors.lastname: Murphy
authors.forename: G
authors.initials: G
authors.lastname: Pylpchuk
authors.forename: E
authors.initials: E
authors.lastname: Toffelmire
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D002170:Canada; D003404:Creatinine / Q000652:urine; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000378:metabolism / Q000503:physiopathology / Q000628:therapy; D005247:Feeding Behavior; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology; D006306:Health Surveys; D006801:Humans; D007676:Kidney Failure, Chronic / Q000378:metabolism / Q000503:physiopathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis; D012709:Serum Albumin / Q000378:metabolism; D016896:Treatment Outcome; D014504:Urban Health
chemical_list: D012709:Serum Albumin; D003404:Creatinine