Late nephrologist referral and mortality assotiation in dialytic patients.
BACKGROUND
Chronic kidney disease is defined by the progressive loss of renal function. Interventions in early stages significantly improve the prognosis of patients with chronic kidney disease, reducing the mortality, and many studies show that early nephrologist referral reduces the mortality rate.


OBJECTIVE
To analyze the characteristics of the patients in dialysis and the time between the first consultation in the dialysis clinic and the beginning of the dialytic program.


METHODS
It was made a cohort retrospective study with two analysis axis: the social and epidemiological characteristics of the patients in hemodialysis and the time between the first consultation in the clinic and the beginning of the dialytic program. Analytical and descriptive methods where used to compare these data with the early referral and the mortality 12 months after the dialysis onset.


RESULTS
One hundred and one patients were analyzed. The mortality rate of the early and lately referred patients was 47.8% and 20.5%, respectively (HR = 2.38; IC = 1.06-5.36; p = 0.035). Concerning the patients which initiated the dialysis with catheter and arteriovenous fistula, the mortality was respectively 51.4% and 10.3% (HR = 4.61; IC = 1,54-13,75; p = 0.006).


CONCLUSIONS
The referral timing was predominantly late. The late referral was associated with a greater mortality. Other variables associated with a greater mortality were age of 70 or more, presence of diabetes and the use of catheter by the dialysis onset.
Universidade do Vale do Itajaí, Brasil.
Henrique
H
Diegoli
Universidade do Vale do Itajaí, Brasil.
Marcelo Castro Gonçalves
MC
Silva
Universidade do Vale do Itajaí, Brasil.
Diogo Spengler Barcelos
DS
Machado
Universidade do Vale do Itajaí, Brasil.
Carlos Eduardo Rilling da Nova
CE
Cruz
D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D009398:Nephrology; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D006435:Renal Dialysis / Q000401:mortality*; D051436:Renal Insufficiency, Chronic / Q000401:mortality* / Q000628:therapy*; D012189:Retrospective Studies; D013997:Time Factors