title: Early nephrology care provided by the nephrologist alone is not sufficient to mitigate the social and psychological aspects of chronic kidney disease.
abstract: OBJECTIVE
  Patients with chronic kidney disease who receive early nephrology care have a better prognosis with maintenance dialysis. We aimed to determine whether early referral to a nephrologist can also improve the psychological burden of having chronic kidney disease.
  
  
  METHODS
  Thirty-nine patients with chronic kidney disease that required hemodialysis were studied: 19 had a $ 6-month history of nephrology care (Group1), and 20 had never received any prior nephrology care (Group2). All patients participated in a semi-structured interview that addressed their perceived knowledge and psychological aspects related to CKD and hemodialysis. Demographic and laboratory data as well as socioeconomic status were evaluated.
  
  
  RESULTS
  In both groups, most of the patients were of low socioeconomic status. Group 1 had significantly better laboratory parameters (p<0.05). The patients' answers to the questions showed no differences between the groups: 63% of Group 1 and 55% of Group 2 reported that they had no prior knowledge about dialysis; 58% and 40%, respectively, reported that they ''don't completely understand what the doctor says''; and 74% and 85%, respectively, believed that their ''kidneys would work again''.
  
  
  CONCLUSIONS
  Pre-dialysis nephrology care improves the clinical conditions of the patients with chronic kidney disease but is insufficient for minimizing other aspects of having chronic kidney disease.
authors.affiliation: Discipline of Nephrology, Faculdade de Medicina, Universidade de São Paulo.
authors.forename: Ana Amélia
authors.initials: AA
authors.lastname: Fayer
authors.forename: Rosemeire
authors.initials: R
authors.lastname: Nascimento
authors.forename: Regina C R M
authors.initials: RC
authors.lastname: Abdulkader
mesh_terms: D004812:Epidemiologic Methods; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007676:Kidney Failure, Chronic / Q000523:psychology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000592:standards* / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000592:standards* / Q000706:statistics & numerical data; D006435:Renal Dialysis / Q000523:psychology*; D012959:Socioeconomic Factors; D013997:Time Factors