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.
Piccoli
Giorgina Barbara
GB
Cattedra di Nefrologia, Department of Internal Medicine, University of Turin, Corsao Dogliotti 14, 10126 Turin, Italy. gbpiccoli@hotmail.com
Soragna
Giorgio
G
Mezza
Elisabetta
E
Putaggio
Stefania
S
Motta
Daria
D
Gai
Massimo
M
Anania
Patrizia
P
Fop
Fabrizio
F
Bermond
Francesca
F
Burdese
Manuel
M
Vaggione
Silvia
S
Malfi
Bernardo
B
Jeantet
Alberto
A
Segoloni
Giuseppe P
GP
Piccoli
Giuseppe
G
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