title: [Relationship between pre-dialysis period and mortality and morbidity; the importance of timely pre-dialysis care].
abstract: OBJECTIVE
  To investigate if the duration of pre-dialysis nephrology care is a predictive factor for mortality and morbidity in the first year of renal replacement therapy (RRT).
  
  
  METHODS
  Cohort study.
  
  
  METHODS
  We included all patients with chronic or acute-on-chronic renal failure whose estimated glomerular filtration time (eGFR) was < 30 ml/min/1.73 m2 6 months before starting RRT and in whom RRT was initiated in 2005-2006 or 2009-2010. Depending on the duration of the pre-dialysis period we allocated patients to the short (< 6 months) or the long (≥ 6 months) pre-dialysis group. Data regarding mortality and morbidity were registered at the initiation of RRT (T0), after 3 (T3), 6 (T6) and 12 (T12) months.
  
  
  RESULTS
  Thirty-nine patients with a short pre-dialysis period and 49 patients with a long pre-dialysis period were included. Patients with a short pre-dialysis period had higher mortality (T6: 23.1% vs. 8.2%; p = 0.05), more hospital stays (2 vs. 1 stay; p = 0.02), and longer hospital stays (16 vs. 3 days; p < 0.01). Additionally, in this group RRT more often had to be started through an acute route of administration for dialysis, which was associated with a higher mortality at T6 (23.8% vs. 6.5%; p = 0.02).
  
  
  CONCLUSIONS
  A too short pre-dialysis period is predictive for higher mortality and morbidity in the first year after initiation of RRT. The necessity for an acute route of administration for dialysis seems to be the most important predictor.
authors.affiliation: VieCuri, Medisch Centrum voor Noord-Limburg, Venlo.
authors.forename: S T Tom
authors.initials: ST
authors.lastname: Laurens
authors.forename: C G T Kitty
authors.initials: CG
authors.lastname: Bex
authors.forename: Loes
authors.initials: L
authors.lastname: Janssen
authors.forename: S G J Suzan
authors.initials: SG
authors.lastname: Jeuken-Mertens
authors.forename: A J Ton
authors.initials: AJ
authors.lastname: Luik
authors.forename: M M H Marc
authors.initials: MM
authors.lastname: Hermans
authors.forename: W H M Willi
authors.initials: WH
authors.lastname: van Kuijk
mesh_terms: D058186:Acute Kidney Injury / Q000401:mortality / Q000628:therapy; D000368:Aged; D015331:Cohort Studies; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000628:therapy*; D007902:Length of Stay; D008297:Male; D009017:Morbidity; D010530:Peritoneal Dialysis; D006435:Renal Dialysis; D017582:Renal Replacement Therapy; D015996:Survival Rate; D013997:Time Factors