[BENEFIT Kidney--significance of a nephrology screening at intervention outset and therapy success].
OBJECTIVE
Early specialist care of patients with renal disease, including timely and planned onset of dialysis, determine the course of the disease, quality of life, hospitalization and life expectancy. A multi-centre enquiry by standardized questionnaire was undertaken to define and analyse medical care of newly dialysis-requiring patients.


METHODS
Data on 551 patients in five different regions of Germany who for the first time required renal replacement treatment were prospectively collected between July 2002 and March 2003. Documentation of history, clinical findings and biochemical tests was done on consecutive patients with a standardized questionnaire, until the desired number of cases was reached.


RESULTS
The mean age of the patients (55.4% males) was 64.8 years. 30.7% had diabetes mellitus, 22.3% arterial hypertension/nephrosclerosis and 16.9% glomerulonephritis/vasculitis. Early predominantly nephrological care had been undertaken in 38.7% of patients. 59.0% were cared for almost exclusively by their general practitioner until the time when dialysis was started. 229 patients (41.6%) were referred to specialist (nephrologists) only when dialysis had become necessary. The onset of dialysis was at the right time in only 50.5% of this group. Comparing the care given by nephrologists with that by general practitioners, elective (i.e. planned) dialysis was begun in 81.0% vs. 48.0% (p<0.05). Hospitalization in the two groups was 54.5% vs. 83.7% (p<0.05), the duration of hospital stay 11.4 vs. 17.4 days (p<0.05).


CONCLUSIONS
Fewer than 40% of patients with chronic renal disease in preterminal renal failure (stage IV) were under the care of nephrologists. The lower the degree of nephrological care the more frequent was there a delay in the onset of dialysis treatment. The incidence and the duration of hospital stay was longer. Structured treatment pathways and incentives need to be formulated to reduce the incidence of wrong or substandard treatment of patients with impaired renal function.
Riegel
W
W
Medizinische Klinik III, Klinikum Darmstadt. W.Riegel@klinikum-darmstadt.de
Hahn
K
K
Kreutz
R
R
Weber
M
M
Zidek
W
W
Schmieder
R
R
D000368:Aged; D003928:Diabetic Nephropathies / Q000150:complications / Q000628:therapy; D042241:Early Diagnosis; D005260:Female; D005858:Germany; D005921:Glomerulonephritis / Q000150:complications; D006760:Hospitalization; D006801:Humans; D006973:Hypertension / Q000150:complications; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D007902:Length of Stay; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009398:Nephrology / Q000592:standards*; D009400:Nephrosclerosis / Q000150:complications; D011446:Prospective Studies; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D006435:Renal Dialysis / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D013997:Time Factors; D014657:Vasculitis / Q000150:complications