Effects of late referral to a nephrologist in patients with chronic renal failure.
BACKGROUND
We lack information about the role of late diagnosis of end-stage renal disease (ESRD), late nephrological referral and its impact on biochemical variables and first hospitalization in East Anatolia, Turkey.


RESULTS
For a total of 101 ESRD patients, dialysis was initiated between January 1998 and December 2002 at the Yuzuncu Yil University Hospital. Early referral (ER) and late referral (LR) were defined as the time of first referral or admission to a nephrologist greater or less than 12 weeks, respectively, before initiation of haemodialysis (HD).


RESULTS
The need for urgent dialysis was less among the early referral cases compared with the late referral cases (P = 0.03). Patients with LR started dialysis with lower levels of haemoglobin (8.6 vs 9.5 g/dL, P < 0.05) bicarbonate (16 vs 12 mEq/lt, P < 0.03) and albumin (2.9 vs 3.29 mg/dL, P < 0.02) and with higher serum levels of blood urea nitrogen (173 vs 95 mg/dL, P < 0.001), creatinine (10 vs 7.9 mg/dL, P < 0.001) and potassium (5.3 vs 4.8, P < 0.04). Hospitalization duration beginning at dialysis was significantly longer in the LR group (27.3 +/- 24) compared with the ER group (13.4 +/- 7.5, P < 0.001). When the groups were compared in terms of distance between the patients home and hospital, there were significantly more patients living far away from hospital (i.e. >100 km) in the LR group compared with the ER (P < 0.0001) group.


CONCLUSIONS
Early referral to a nephrology unit and/or early diagnosis of ESRD results in better biochemical variables, shorter first hospitalization length and a higher percentage of elective construction of AVF and the availability to start with an alternative dialysis modality (i.e. CAPD).
Dogan
Ekrem
E
Department of Internal Medicine, Division of Nephrology, Medical Faculty, Sutcu Imam University, Kahramanmaras, Turkey. ekremdogan68@yahoo.com
Erkoc
Reha
R
Sayarlioglu
Hayriye
H
Durmus
Ahmet
A
Topal
Cevat
C
D000328:Adult; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis* / Q000628:therapy*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009398:Nephrology / Q000706:statistics & numerical data; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000706:statistics & numerical data; D006435:Renal Dialysis / Q000706:statistics & numerical data; D013997:Time Factors; D014421:Turkey