title: Type of Referral, Dialysis Start and Choice of Renal Replacement Therapy Modality in an International Integrated Care Setting.
abstract: Integrated Care Settings (ICS) provide a holistic approach to the transition from chronic kidney disease into renal replacement therapy (RRT), offering at least both types of dialysis.
  
  
  
  To analyze which factors determine type of referral, modality provision and dialysis start on final RRT in ICS clinics.
  
  
  
  Retrospective analysis of 626 patients starting dialysis in 25 ICS clinics in Poland, Hungary and Romania during 2012. Scheduled initiation of dialysis with a permanent access was considered as planned RRT start.
  
  
  
  Modality information (80% of patients) and renal education (87%) were more frequent (p<0.001) in Planned (P) than in Non-Planned (NP) start. Median time from information to dialysis start was 2 months. 89% of patients started on hemodialysis, 49% were referred late to ICS (<3 months from referral to RRT) and 58% were NP start. Late referral, non-vascular renal etiology, worse clinical status, shorter time from information to RRT and less peritoneal dialysis (PD) were associated with NP start (p<0.05). In multivariate logistic regression analysis, P start (p≤0.05) was associated with early referral, eGFR >8.2 ml/min, >2 months between information and RRT initiation and with vascular etiology after adjustment for age and gender. "Optimal care," defined as ICS follow-up >12 months plus modality information and P start, occurred in 23%.
  
  
  
  Despite the high rate of late referrals, information and education were widely provided. However, NP start was high and related to late referral and may explain the low frequency of PD.
authors.affiliation: Diaverum Home Therapies, Medical Office, Munich, Germany.
authors.forename: Belén
authors.initials: B
authors.lastname: Marrón
authors.affiliation: Wloclawek Diaverum Clinic, Wloclawek, Poland.
authors.forename: Janusz
authors.initials: J
authors.lastname: Ostrowski
authors.affiliation: Szeged Diaverum Clinic, Szeged, Hungary.
authors.forename: Marietta
authors.initials: M
authors.lastname: Török
authors.affiliation: Semaparc Diaverum Clinic, Bucharest, Romania.
authors.forename: Delia
authors.initials: D
authors.lastname: Timofte
authors.affiliation: Bajcsy Diaverum Clinic, Budapest, Hungary.
authors.forename: Attila
authors.initials: A
authors.lastname: Orosz
authors.affiliation: Przemysl Diaverum Clinic, Przemysl, Poland.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Kosicki
authors.affiliation: Olsztyn Diaverum Clinic, Olsztyn, Poland.
authors.forename: Alicja
authors.initials: A
authors.lastname: Całka
authors.affiliation: Sibiu Distributei Diaverum Clinic, Sibiu, Romania.
authors.forename: Daniela
authors.initials: D
authors.lastname: Moro
authors.affiliation: Zalaegerszeg Diaverum Clinic, Zalaegerszeg, Hungary.
authors.forename: Dezider
authors.initials: D
authors.lastname: Kosa
authors.affiliation: Szolnok Diaverum Clinic, Szolnok, Hungary.
authors.forename: Jenö
authors.initials: J
authors.lastname: Redl
authors.affiliation: Division of Renal Medicine, CLINTEC, Karolinska Institute, Stockholm, Sweden.
authors.forename: Abdul Rashid
authors.initials: AR
authors.lastname: Qureshi
authors.affiliation: Division of Renal Medicine, CLINTEC, Karolinska Institute, Stockholm, Sweden.
authors.forename: Jose Carolino
authors.initials: JC
authors.lastname: Divino-Filho
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002755:Choice Behavior; D019033:Delivery of Health Care, Integrated / Q000639:trends*; D005260:Female; D006801:Humans; D007390:International Agencies; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012017:Referral and Consultation; D006435:Renal Dialysis; D017582:Renal Replacement Therapy; D012189:Retrospective Studies; D013997:Time Factors