title: Timely referral to the nephrologist: essential to optimizing patient outcomes.
abstract: Annual mortality on renal replacement therapy is about 10% in Western Europe and reaches 20% in the United States. The reasons responsible for this excess mortality include among others advanced age, high prevalence of diabetes and comorbid conditions, susceptibility to infections, and cancer. An additional cause that should be considered is late referral to overall renal care and for renal replacement therapy. It has been demonstrated recently that early referral may provide many advantages for the patient, such as prevention of organ damage secondary to uremia and even delay the onset of end-stage renal disease. These benefits prompted numerous recommendations for timely referral, both for dialysis and for long-term renal follow-up. Despite available guidelines for nephrology referral the current practice is still suboptimal, resulting in delayed initiation of dialysis and clinical outcomes that are not ideal. There is an urgent need in the renal community to change the current practice of referral. Beyond the benefits for patients, society may also expect potential cost effectiveness from early renal care.
authors.affiliation: Chair and Department of Nephrology, Medical Faculty, Jagiellonian University, Krakow, Poland. wladsul@mp.pl
authors.forename: Władysław
authors.initials: W
authors.lastname: Sułowicz
authors.forename: Tomasz P
authors.initials: TP
authors.lastname: Stompór