title: Timing of nephrology referral: influence on mortality and morbidity in chronic kidney disease.
abstract: BACKGROUND
  Few studies in India as well as in most developing countries have compared the mortality and morbidity rates between chronic kidney disease patients who were referred early to nephrologists and those who were referred late.
  
  
  OBJECTIVE
  To study the mortality and morbidity patterns and to compare the various clinical parameters between the abovementioned early and late referrals.
  
  
  METHODS
  Fifty consecutive chronic kidney disease patients were followed up for one year. They were then classified as early referral (patients who underwent dialysis more than three months after the referral) and late referral (patients who underwent dialysis within three months of the referral). Clinical, laboratory parameters, and mortality patterns were compared between the two groups.
  
  
  RESULTS
  The blood pressure, hemoglobin, glomerular filtration rate, and calcium and phosphate values were better in the early referral group. Among the 24 complications that occurred, 17 (70.8%) were seen among the patients who were referred late. Among the 13 deaths that occurred, only one belonged to the early referral group.
  
  
  CONCLUSIONS
  We observed that the mortality rate and clinical parameters were better in patients who were referred early to nephrologists.
authors.affiliation: Department of Medicine, Kasturba Medical College- Mangalore, Manipal University, Mangalore, India.
authors.forename: Sushanth
authors.initials: S
authors.lastname: Kumar
authors.forename: Jayakumar
authors.initials: J
authors.lastname: Jeganathan
authors.lastname: Amruthesh
keywords: Morbidity; Mortality; Nephrology; Renal Insufficiency