title: Slowing renal function decline in chronic kidney disease patients after nephrology referral.
abstract: OBJECTIVE
  Late referral of chronic kidney disease (CKD) patients to nephrologists is associated with increased morbidity and mortality and is still quite common and seldom studied in Taiwan because of unique sociocultural factors. We aimed to study the decline in renal function and factors related to the change in renal function before and after referral.
  
  
  METHODS
  We retrospectively reviewed the changes of estimated glomerular filtration rate (eGFR) in 213 new referrals of patients with CKD stages 3-5 to the nephrology divisions of one medical centre and one regional hospital from 2001-2006. Data on demographics and laboratory investigations were collected for study.
  
  
  RESULTS
  The rates of annual eGFR decline slowed significantly from -7.38 +/- 0.84 before referral to -1.02 +/- 0.45 mL/min per 1.73 m(2)/year after referral (mean +/- standard error of the mean, P < 0.001). The nephrology referral was the most significant factor associated with the slowing of renal function progression, as was younger age and female sex. After nephrology referral, patients with diabetes had an increase in eGFR compared to those without diabetes (P = 0.034). Patients had better control of diastolic blood pressure, sugar and lipid, more frequent use of angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers and statins, less frequent use of non-steroidal anti-inflammatory drugs, and more serum creatinine measurements after nephrology referral.
  
  
  CONCLUSIONS
  Slowing renal functional decline in CKD patients after referral addresses the importance of nephrology referral for CKD care, which should be strongly promoted in CKD prevention projects in Taiwan.
authors.affiliation: Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Szu-Chia
authors.initials: SC
authors.lastname: Chen
authors.forename: Jer-Ming
authors.initials: JM
authors.lastname: Chang
authors.forename: Ming-Chin
authors.initials: MC
authors.lastname: Chou
authors.forename: Ming-Yen
authors.initials: MY
authors.lastname: Lin
authors.forename: Jui-Hsin
authors.initials: JH
authors.lastname: Chen
authors.forename: Jia-Hui
authors.initials: JH
authors.lastname: Sun
authors.forename: Jinn-Yuh
authors.initials: JY
authors.lastname: Guh
authors.forename: Shang-Jyh
authors.initials: SJ
authors.lastname: Hwang
authors.forename: Hung-Chun
authors.initials: HC
authors.lastname: Chen
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001794:Blood Pressure; D002784:Cholesterol / Q000097:blood; D002908:Chronic Disease; D003404:Creatinine / Q000097:blood; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007674:Kidney Diseases / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D007676:Kidney Failure, Chronic / Q000097:blood / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D009398:Nephrology; D012017:Referral and Consultation; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012737:Sex Factors; D013624:Taiwan; D013997:Time Factors; D014280:Triglycerides / Q000097:blood
chemical_list: D002784:Cholesterol; D003404:Creatinine; D006442:Glycated Hemoglobin; D014280:Triglycerides; C517652:hemoglobin A1c protein, human