title: Nephrologist care for 12 months or more increases hemodialysis initiation with permanent vascular access.
abstract: BACKGROUND
  The objective of this study was to evaluate the effect of early referral (ER) to nephrologists on the type of vascular access (VA) available for use at the time of initiation of maintenance hemodialysis (HD). In patients who have been followed by nephrologists for less than 3 months, management before the initiation of HD is often insufficient and urgent initiation of HD is often necessary; therefore, patients in this study were limited to those who had been followed for at least 3 months by nephrologists.
  
  
  METHODS
  Nine hundred and forty patients at 9 institutions affiliated to our study group were enrolled in this retrospective observational study.                         We defined patients followed up by nephrologists for at least 12 months as the early referral (ER) group and those followed for between 3 and 12 months as the late referral (LR) group. The type of VA available for use at the initiation of maintenance HD was compared between the groups.
  
  
  RESULTS
  Early referral was found to be significantly associated with the availability of a permanent VA, which included an arteriovenous fistula or arteriovenous graft, at the time of initiation of HD (odds ratio [OR] 1.705; P = 0.001). Multivariate analysis also revealed ER to be significantly associated with the availability of a permanent VA (OR 1.509; P = 0.023).
  
  
  CONCLUSIONS
  Early referral was shown to be advantageous for increasing the likelihood of availability of a permanent VA, even after patients who had been followed up for less than 3 months by nephrologists were excluded.
authors: Department of Nephrology, Nagoya Daini Red Cross Hospital, Myoken-cho 2-9, Showa-Ku, Nagoya, Aichi, 466-8650, Japan. inaguma@nagoya2.jrc.or.jp.
authors: Daijo
authors: D
authors: Inaguma
authors: Study Group for Assessing Initiation of Renal Replacement Therapy, Tokyo, Japan.
authors: Ryoichi
authors: R
authors: Ando
authors: Study Group for Assessing Initiation of Renal Replacement Therapy, Tokyo, Japan.
authors: Masato
authors: M
authors: Ikeda
authors: Study Group for Assessing Initiation of Renal Replacement Therapy, Tokyo, Japan.
authors: Nobuhiko
authors: N
authors: Joki
authors: Study Group for Assessing Initiation of Renal Replacement Therapy, Tokyo, Japan.
authors: Fumihiko
authors: F
authors: Koiwa
authors: Study Group for Assessing Initiation of Renal Replacement Therapy, Tokyo, Japan.
authors: Yasuhiro
authors: Y
authors: Komatsu
authors: Study Group for Assessing Initiation of Renal Replacement Therapy, Tokyo, Japan.
authors: Toshihumi
authors: T
authors: Sakaguchi
authors: Study Group for Assessing Initiation of Renal Replacement Therapy, Tokyo, Japan.
authors: Toshio
authors: T
authors: Shinoda
authors: Study Group for Assessing Initiation of Renal Replacement Therapy, Tokyo, Japan.
authors: Toshihiko
authors: T
authors: Yamaka
authors: Study Group for Assessing Initiation of Renal Replacement Therapy, Tokyo, Japan.
authors: Takashi
authors: T
authors: Shigematsu
mesh_terms: D000368:Aged; D002408:Catheters, Indwelling / Q000706:statistics & numerical data*; D048909:Diabetes Complications / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009398:Nephrology; D012017:Referral and Consultation; D006435:Renal Dialysis / Q000379:methods*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome