Lost to follow-up: the bottleneck of early referral to renal units?
BACKGROUND
Early referral is a major goal in chronic kidney diseases; however, loss to follow-up, potentially limiting its advantages, has never been studied.


METHODS
In order to assess the prevalence and causes of loss to follow-up, a telephone inquiry was performed in a renal outpatient unit, mainly dedicated to early referral of diabetic patients. Patients were considered to be in follow-up if there was at least one check-up in the period February 2001-February 2002, and lost to follow-up if the last check-up had occurred in the previous year. The reasons for loss to follow-up were related to typical clinical-biochemical parameters to define a "drop-out profile".


RESULTS
195 patients were on follow-up: median creatinine 1.4 mg/dL, age 64, 76.9% diabetics. 81 patients were lost to follow-up: creatinine 1.4 mg/dL, age 70, 73.8% diabetics. A telephone number was available in 87.6% of the cases; 25 were not found, 7 had died, 24 were non-compliant, 1 was bed-ridden, 12 had changed care unit, 2 had started dialysis. Renal care was shorter in those lost to follow-up; among the latter, serum creatinine and age were significantly lower in non-compliant patients. A logistic regression model confirmed the significance of lower serum creatinine at last check-up in non-compliant patients (p=0.018).


CONCLUSIONS
Loss to follow-up is a problem in nephrology; lack of awareness probably causes the higher drop-out rate at lower creatinine levels. The initial period of care may be crucial for long-term compliance. Further studies are needed to tailor organizational and educational interventions.
Cattedra di Nefrologia, Department of Internal Medicine, University of Turin, Corsao Dogliotti 14, 10126 Turin, Italy. gbpiccoli@hotmail.com
Giorgina Barbara
GB
Piccoli
Giorgio
G
Soragna
Elisabetta
E
Mezza
Stefania
S
Putaggio
Daria
D
Motta
Massimo
M
Gai
Patrizia
P
Anania
Fabrizio
F
Fop
Francesca
F
Bermond
Manuel
M
Burdese
Silvia
S
Vaggione
Bernardo
B
Malfi
Alberto
A
Jeantet
Giuseppe P
GP
Segoloni
Giuseppe
G
Piccoli
D000368:Aged; D003404:Creatinine / Q000097:blood; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D007674:Kidney Diseases / Q000175:diagnosis / Q000628:therapy*; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital; D012017:Referral and Consultation; D012044:Regression Analysis; D016312:Treatment Refusal
D003404:Creatinine