Impact of early nephrology referral on mortality and hospitalization in peritoneal dialysis patients.
OBJECTIVE
Several studies have examined the possible association between late referral to a nephrologist and mortality on maintenance hemodialysis. However, we lack information on the benefit of early nephrologist referral in patients receiving peritoneal dialysis (PD).


METHODS
In an inception cohort of 102 consecutive PD patients identified in a single center between 2003 and 2004, we sought to determine whether late nephrologist referral was associated with poor outcomes. The primary end point was all-cause mortality. The effects of early referral to a multidisciplinary low clearance clinic on cardiovascular mortality and length of hospitalization were also evaluated.


RESULTS
Of 102 incident PD patients, 61 subjects (59.8%) were referred early to the nephrologist (more than 3 months) before dialysis initiation. During the study period of 284.9 patient-years (median follow-up period 36.8 months), 25 patients died, 12 due to cardiovascular causes. Both cardiovascular and all-cause mortality were significantly increased among PD patients with late referral, but the relationship between late referral and all-cause mortality was mitigated substantially by adjusting for relevant factors. In univariate analysis, late nephrology referral was associated with increased cardiovascular mortality, with a hazard ratio of 5.43 (95% confidence interval 1.46 - 20.21, p = 0.012). Annual adjusted days of hospitalization were similar between the early and late nephrology referral groups.


CONCLUSIONS
A comprehensive analysis of incident PD subjects confirmed the significant relationship between late nephrology referral and all-cause and cardiovascular mortality. A causal relationship remains to be established and validated.
Chow
Kai Ming
KM
Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong, SAR, China. Chow_Kai_Ming@alumni.cuhk.net
Szeto
Cheuk Chun
CC
Law
Man Ching
MC
Kwan
Bonnie Ching-Ha
BC
Leung
Chi Bon
CB
Li
Philip Kam-Tao
PK
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000150:complications / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009398:Nephrology; D010530:Peritoneal Dialysis / Q000401:mortality*; D010819:Physician's Role; D016016:Proportional Hazards Models; D012017:Referral and Consultation; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome