[The optimization of the treatment and timing of the intervention by a nephrologist in pre-dialytic chronic renal insufficiency].
BACKGROUND
Early referral to nephrologists of patients with chronic renal failure (CRF) reduces morbidity and mortality in dialysis. Aim of this work is to evaluate the condition of early and late referral, and whether the two different conditions can affect the treatments.


METHODS
This is a prospective study with a 12-month follow-up period. During this time, we verified the prevalence of patients with serum creatinine > 1.5 mg/dL (CRF patients) and the condition of early or late referral, defined as referral to nephrologists for > or < 3 times during follow up, respectively. Diagnosis of diabetes mellitus and/or arterial hypertension, and the use of antihypertensive drugs, insulin, hypoproteic diet and erythropoietin was recorded in each patient.


RESULTS
CRF (mean serum creatinine value = 2.11+/-1.52 mg/dL) was observed in 190 patients aged 72.05+/-11.62 years. The prevalence of CRF was 4718 pmp. Diabetes and hypertension were diagnosed in 107 subjects (56.3%) and 152 subjects (80%), respectively. Only 74.2% (no. 141) of the patients with CRF was habitually followed by the nephrologist and the frequency was directly correlated to the degree of CRF: 100% of the patients with Creatinine Clearance (Cr Cl) < 25 mL/min, 70% with Cr Cl >25 < 50, and 0% with Cr Cl >50 < 80 mL/min. Early referral was coupled with a wider use of a hypoproteic diet, erythropietin, and the association ACE-I + Angiotensin II receptor antagonists.


CONCLUSIONS
In conclusion, our data show a prevalence of CRF that is at least 5 times greater than that of dialysis patients. The condition of late referral is present in about 30% of the CRF population from the time of the initial phases of renal disease. Referral time affects the modalities of the treatment.
Sirignano
C
C
Medicina Generale del Distretto n. 9 di Montoro Superiore (AV).
D'Urso
P
P
Di Iorio
B R
BR
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D002648:Child; D003131:Combined Modality Therapy; D015897:Comorbidity; D003404:Creatinine / Q000097:blood; D003920:Diabetes Mellitus / Q000188:drug therapy / Q000453:epidemiology; D018753:Diet, Protein-Restricted; D004921:Erythropoietin / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000453:epidemiology; D007328:Insulin / Q000627:therapeutic use; D007558:Italy / Q000453:epidemiology; D007676:Kidney Failure, Chronic / Q000097:blood / Q000178:diet therapy / Q000188:drug therapy / Q000453:epidemiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012017:Referral and Consultation / Q000706:statistics & numerical data; D013997:Time Factors; D014511:Uremia / Q000453:epidemiology
D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D007328:Insulin; D004921:Erythropoietin; D003404:Creatinine