title: Impact of early referral to nephrologist on mental health among hemodialysis patients: a Dialysis Outcomes and Practice Patterns Study (DOPPS).
abstract: BACKGROUND
  Pre-dialysis early referral is associated with improved survival in patients on dialysis. Here, we examined the association between pre-dialysis early referral and post-dialysis Mental Health (MH) in hemodialysis patients.
  
  
  METHODS
  We examined data from the Dialysis Outcomes and Practice Patterns Study (DOPPS), a prospective and observational study of hemodialysis patients, by performing a cross-sectional and longitudinal analysis of DOPPS data from Japan. The outcome measure was analyzed from the MH subscale of the Medical Outcomes Study Short Form-36 Item Health Survey. Predictors of mean MH were identified using analysis of covariance. The variables evaluated in the multivariate models included age, sex, duration of dialysis and diabetes.
  
  
  RESULTS
  A total of 552 patients under hemodialysis participated in the study, with a late referral prevalence of 34.2% (189/552). The estimated mean MH score was 60.7 (95% confidence interval (CI) 57.5-63.8) and 65.6 (95% CI 63.2-68.1) in late and early referrals, respectively. A statistically significant difference in mean MH score of 4.9 was observed between late and early referral groups (p = 0.01). The mean MH score for late referral was significantly lower than that for early referral in the 6-12 and 12-18 month groups.
  
  
  CONCLUSIONS
  Pre-dialysis early referral is a modifiable and important factor and is associated with improved MH of post-dialysis patients.
authors: Department of Epidemiology and Healthcare Research, Kyoto University Graduate School of Medicine, Yoshida-konoe, Kyoto, Japan. yokoyokoyama@pbh.mbox.media.kyoto-u.ac.jp
authors: Yoko
authors: Y
authors: Yokoyama
authors: Shin
authors: S
authors: Yamazaki
authors: Takeshi
authors: T
authors: Hasegawa
authors: Takafumi
authors: T
authors: Wakita
authors: Yasuaki
authors: Y
authors: Hayashino
authors: Misa
authors: M
authors: Takegami
authors: Takashi
authors: T
authors: Akiba
authors: Tadao
authors: T
authors: Akizawa
authors: Yasushi
authors: Y
authors: Asano
authors: Akira
authors: A
authors: Saito
authors: Kiyoshi
authors: K
authors: Kurokawa
authors: Shunichi
authors: S
authors: Fukuhara
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D038622:Internationality; D008137:Longitudinal Studies; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D009398:Nephrology / Q000379:methods; D010820:Physicians; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D012017:Referral and Consultation; D006435:Renal Dialysis / Q000523:psychology*; D013997:Time Factors; D016896:Treatment Outcome