title: Early referral and planned initiation of dialysis: what impact on quality of life?
abstract: BACKGROUND
  Early patient referral correlates with improved patient survival on dialysis. We examine whether early referral and a planned first dialysis affect quality of life (QoL).
  
  
  METHODS
  All patients commencing dialysis in nine centres in seven European countries between 1 July 1998 and 31 October 1999 were recruited.
  
  
  BACKGROUND
  early referral=followed by a nephrologist >1 month before first dialysis (<1 month=late referral); planned=early referral and previous serum creatinine >300 micro mol/l and non-urgent first dialysis (early referral and no creatinine >300 micro mol/l or urgent first dialysis=unplanned). QoL was measured at 8 weeks using a visual analogue scale (VAS) and Short Form 36 (SF-36).
  
  
  RESULTS
  VAS was significantly higher in early referral patients [mean (SD) 58.4 (20) vs 50.4 (19), P=0.005], particularly if the first dialysis was planned [60.7 (20) vs 54.2 (20), P=0.03]. Planned patients also had higher SF-36 mental summary scores [45.4 (12) vs 39.7 (11), P=0.003], role emotional scores [58.0 (43) vs 30.9 (38), P=0.003], and mental health scores [63.7 (24) vs 54.6 (22), P=0.01] than unplanned patients. Adjusting for centre and other confounding variables showed that having a planned first dialysis had an independent effect on QoL (VAS, and the SF-36's mental summary score, physical functioning, role physical, general health, role emotional and mental health). Early referral had no independent effect on QoL. Socio-economic status had an important positive effect on physical QoL.
  
  
  CONCLUSIONS
  While the effect of early referral to a nephrologist on QoL appeared centre dependent, a smooth transition onto dialysis was associated with significantly better early QoL, independent of other variables.
authors.affiliation: Medicine and Therapeutics, University of Aberdeen, UK. f.caskey@abdn.ac.uk
authors.forename: Fergus J
authors.initials: FJ
authors.lastname: Caskey
authors.forename: Sarah
authors.initials: S
authors.lastname: Wordsworth
authors.forename: Thomas
authors.initials: T
authors.lastname: Ben
authors.forename: Frank T
authors.initials: FT
authors.lastname: de Charro
authors.forename: Catherine
authors.initials: C
authors.lastname: Delcroix
authors.forename: Vladimir
authors.initials: V
authors.lastname: Dobronravov
authors.forename: Henk
authors.initials: H
authors.lastname: van Hamersvelt
authors.forename: Iain
authors.initials: I
authors.lastname: Henderson
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Kokolina
authors.forename: Izhar H
authors.initials: IH
authors.lastname: Khan
authors.forename: Anne
authors.initials: A
authors.lastname: Ludbrook
authors.forename: Merike
authors.initials: M
authors.lastname: Luman
authors.forename: Gordon J
authors.initials: GJ
authors.lastname: Prescott
authors.forename: Dimitri
authors.initials: D
authors.lastname: Tsakiris
authors.forename: Myftar
authors.initials: M
authors.lastname: Barbullushi
authors.forename: Alison M
authors.initials: AM
authors.lastname: MacLeod
mesh_terms: D000328:Adult; D000368:Aged; D002985:Clinical Protocols; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011788:Quality of Life; D012017:Referral and Consultation; D006435:Renal Dialysis; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D015996:Survival Rate; D013997:Time Factors