title: [Influence of early or late referral to nephrologist over morbidity and mortality in hemodialysis].
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.
  
  
  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).
  
  
  CONCLUSIONS
  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.affiliation: Servicio de Nefrología, Hospital General Universitario de Albacete, Hermanos Falcó, s/n 02002 Albacete. eduardogallego@ono.com
authors.forename: E
authors.initials: E
authors.lastname: Gallego
authors.forename: A
authors.initials: A
authors.lastname: López
authors.forename: I
authors.initials: I
authors.lastname: Lorenzo
authors.forename: E
authors.initials: E
authors.lastname: López
authors.forename: F
authors.initials: F
authors.lastname: Llamas
authors.forename: M L
authors.initials: ML
authors.lastname: Illescas
authors.forename: E
authors.initials: E
authors.lastname: Andrés
authors.forename: A
authors.initials: A
authors.lastname: Serrano
authors.forename: E
authors.initials: E
authors.lastname: Olivas
authors.forename: C
authors.initials: C
authors.lastname: Gómez Roldán
mesh_terms: D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009398:Nephrology; D006435:Renal Dialysis / Q000379:methods / Q000401:mortality*; D012306:Risk; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome