Late referral for chronic kidney disease patients: nutritional point of view.
The prevalence of late referral of patients with chronic kidney disease (CKD) is high and has been associated with a worse CKD prognosis, however few studies have been conducted from a nutritional perspective.


OBJECTIVE
Characterize the nutritional status of patients with CKD at first attendance in a nephrology service, with early (ER) and late referral (LR).


METHODS
It was a cross-sectional study with patients older than 18 years referred to the Nephrology service of a University Hospital. The referral groups were classified according to estimated glomerular filtration rate (eGFR) as: LR (eGFR15 ml/min/1.73m2) based on the Kidney Disease Outcomes Quality Initiative. Nutritional evaluation included subjective global assessment (SGA), anthropometric, laboratory and bioelectrical impedance data. The SAS software was used for statistical analysis.


RESULTS
Seventy-five patients were evaluated, 29% of them belonging to the LR group. This group showed a greater previous weight loss (-7.0 ± 3.5 versus -2.8 ± 7.0 Kg) and lower values for all anthropometric and body composition variables. In general, the laboratory results of the LR group also were worse. According to the SGA, all LR patients had some degree of malnutrition (50% with severe malnutrition against 28.8% in ER), showing significantly lower results for GFR (21.4 + 12.2 ml/ min/1.73 m2), albumin (3.9 + 0.3 g/dL), serum bicarbonate (22.8 + 5.1 mmol/L) and phase angle (5.3+ 0.6 θ). Renal function was positively correlated with percent adequacy of arm circumference (r=0,40; p<0,01) and albumin (r=0,45; p<0,01).


CONCLUSIONS
The LR group showed a worse nutritional status showing that, for the nutritional point of view, the delayed referral brings substantial losses that can make difference in future treatment, thus demonstrating the importance of early nutritional monitoring for this population.
Medical School of Ribeirão Preto, University of São Paulo. Brazil.. lari_neto@hotmail.com.
Daiane Cristina
DC
Guerra
Medical School of Ribeirão Preto, University of São Paulo. Brazil.. lari_neto@hotmail.com.
Larissa
L
Rodrigues Neto Angéloco
Medical School of Ribeirão Preto, University of São Paulo. Brazil.. lari_neto@hotmail.com.
Wander R
WR
Furtado
Medical School of Ribeirão Preto, University of São Paulo. Brazil.. lari_neto@hotmail.com.
Eduardo
E
Barbosa Coelho
Medical School of Ribeirão Preto, University of São Paulo. Brazil.. lari_neto@hotmail.com.
Paula
P
Garcia Chiarello
D000138:Acidosis / Q000097:blood / Q000453:epidemiology; D000368:Aged; D000886:Anthropometry; D001639:Bicarbonates / Q000097:blood; D001823:Body Composition; D003430:Cross-Sectional Studies; D017097:Electric Impedance; D005919:Glomerular Filtration Rate; D006801:Humans; D008055:Lipids / Q000097:blood; D044342:Malnutrition / Q000097:blood / Q000453:epidemiology*; D008875:Middle Aged; D015596:Nutrition Assessment; D009752:Nutritional Status; D050177:Overweight / Q000453:epidemiology; D011379:Prognosis; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000453:epidemiology*; D012709:Serum Albumin / Q000032:analysis; D013997:Time Factors
D001639:Bicarbonates; D008055:Lipids; D012709:Serum Albumin