title: Early referral as an independent predictor of clinical outcome in end-stage renal disease on hemodialysis and continuous ambulatory peritoneal dialysis.
abstract: OBJECTIVE
  To evaluate the influence of early nephrology referral on clinical outcome in patients on maintenance hemodialysis (HD) and peritoneal dialysis (PD).
  
  
  METHODS
  This study retrospectively analyzed patients entering our HD and PD program from February 2000 to June 2003. Patients who presented to a nephrologist more than 6 months before starting dialysis were defined as early referral (ER). Meanwhile, patients transferred to the nephrology department less than 6 months before initial dialysis were considered late referral (LR). RESULTS HD GROUPS: Of 78 HD patients, 37 (47.1%) qualified for the ER group and 41 (52.6%) were designated to the LR group. The demographic data were analyzed for both the HD and PD groups. No significant differences in average age at dialysis, duration of hemodialysis, and gender were noted between these two groups. The same applied for the biochemical parameters in both groups. HD patients with early referral had significantly better survival (p < .05) as plotted with the Kaplan-Meier method. In univariate analysis by cox proportional hazards mode, the early referral in HD patients [Exp (Coef) = 0.426, P < .01] significantly influenced survival. The various variables were further examined by multivariate analysis, and early referral, hemoglobin, and age still significantly impacted patient survival (P < .05). CAPD GROUPS: The survival curve related to early referral in continuous ambulatory peritoneal dialysis (CADP) patient survival rate was significantly higher for the early referral groups (P < .05). In addition, a multivariate analysis adjusting for several potential risk factors found that referral time remained significantly associated with patient survival. In additional, hemoglobin and age were significant and independent predictors of mortality.
  
  
  CONCLUSIONS
  This study demonstrates that time between referral and starting dialysis is a predictor of survival for both HD and PD patients, with early referral being associated with longer survival time. These analytical results suggest that early referral before dialysis is important in determining long-term prognosis in HD and PD patients.
authors.affiliation: Division of Nephrology, Chang-Gung Memorial Hospital, Chiayi, Taiwan. Linchunliang@adm.cgmh.org.tw
authors.forename: Chun-Liang
authors.initials: CL
authors.lastname: Lin
authors.forename: Feng-Rong
authors.initials: FR
authors.lastname: Chuang
authors.forename: Ching-Fang
authors.initials: CF
authors.lastname: Wu
authors.forename: Cheng-Ta
authors.initials: CT
authors.lastname: Yang
mesh_terms: D000367:Age Factors; D000418:Albumins / Q000032:analysis; D002784:Cholesterol / Q000097:blood; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010531:Peritoneal Dialysis, Continuous Ambulatory; D011379:Prognosis; D012017:Referral and Consultation; D006435:Renal Dialysis; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000418:Albumins; D006454:Hemoglobins; D002784:Cholesterol