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Late referral for end-stage renal disease: a region-wide survey in the south west of England

Late referral for end-stage renal disease: a region-wide survey in the south west of England
Late referral for end-stage renal disease: a region-wide survey in the south west of England
Background: The proportion of patients referred for renal replacement therapy (RRT) at a late stage of disease appears to be similar to that first described nearly 20 years ago. This study investigated the current scale of the problem in a large region in England, identifying the prior health care, patient characteristics, referral pattern, and outcomes of those accepted onto RRT.
Methods: Three hundred and sixty-one (88%) out of 411 patients accepted for RRT in six renal units in the South and West Region of the UK between 1 June 1996 and 31 May 1997 were studied retrospectively. We examined the history of chronic renal failure, referral path to nephrologist, management of chronic renal failure (CRF) and patient outcomes. Patients were categorized as ‘late’ if they were referred to the renal unit either within 4 months or within 1 month of requiring RRT.
Results: One hundred and twenty-four (35%) patients were referred within 4 months of RRT, and 84 (23%) within 1 month. The main differences between patients referred later and other patients was seen for those referred within 1 month. These patients were older and had more co-morbidity, significantly worse laboratory parameters at the start of RRT, were less likely to have received standard treatments for CRF, had less permanent dialysis access in place at the start of RRT (18% vs 47%, P=0.001), and had a significantly longer hospital stay (18 vs 10 days, P=0.001). Seventy-four (19%) patients died in the first 6 months: 27 (32%) in the 1-month group, 46 (16%) in all others (P=0.002). We found no evidence that patients referred late had defaulted from nephrology follow-up or had an excess of rapidly progressive disease. Though data were incomplete, there was evidence of prior CRF of over 1 year in all late referral groups.
Conclusion: Nearly a quarter of patients are referred for specialist nephrology treatment at a very late stage, within 1 month of RRT. They are less likely to receive interventions that could alter the progression of CRF or reduce its associated co-morbidity, have a worse clinical state at the start of RRT, longer hospitalization and poorer survival. These differences were much less marked for those referred within 1–4 months of starting RRT, although this is an insufficient time to prepare for RRT. Further research is needed to determine the missed opportunities for more proactive diagnosis and management of CRF.
chronic renal failure, early intervention, end-stage renal disease, late referral, renal replacement therapy
0931-0509
1252-1259
Roderick, Paul
dbb3cd11-4c51-4844-982b-0eb30ad5085a
Jones, Chris
93ef9692-7414-40e6-adb5-948edb2b7424
Drey, Nick
14a5c546-0e86-45a2-b53a-c50021c12295
Blakeley, Sara
39e8831e-8762-4067-9657-b63e9ac1e767
Webster, Premila
dd8ba73f-17e4-4044-8c77-3ce91ebbc8c5
Goddard, Jonathan
5b672b3e-48f1-46c7-8771-1d7b12352365
Garland, Sue
7ae63ecd-6753-4023-b21b-f228d988b03f
Bourton, Linda
cf897f77-b685-431d-9dcc-46b98640cf9b
Mason, Juan
3100af92-384e-44ff-ad79-02ba359b9bcf
Tomson, Charlie
a198db93-e002-4fc5-af35-4a3b2b8af444
Roderick, Paul
dbb3cd11-4c51-4844-982b-0eb30ad5085a
Jones, Chris
93ef9692-7414-40e6-adb5-948edb2b7424
Drey, Nick
14a5c546-0e86-45a2-b53a-c50021c12295
Blakeley, Sara
39e8831e-8762-4067-9657-b63e9ac1e767
Webster, Premila
dd8ba73f-17e4-4044-8c77-3ce91ebbc8c5
Goddard, Jonathan
5b672b3e-48f1-46c7-8771-1d7b12352365
Garland, Sue
7ae63ecd-6753-4023-b21b-f228d988b03f
Bourton, Linda
cf897f77-b685-431d-9dcc-46b98640cf9b
Mason, Juan
3100af92-384e-44ff-ad79-02ba359b9bcf
Tomson, Charlie
a198db93-e002-4fc5-af35-4a3b2b8af444

Roderick, Paul, Jones, Chris, Drey, Nick, Blakeley, Sara, Webster, Premila, Goddard, Jonathan, Garland, Sue, Bourton, Linda, Mason, Juan and Tomson, Charlie (2002) Late referral for end-stage renal disease: a region-wide survey in the south west of England. Nephrology, Dialysis, Transplantation, 17 (7), 1252-1259.

Record type: Article

Abstract

Background: The proportion of patients referred for renal replacement therapy (RRT) at a late stage of disease appears to be similar to that first described nearly 20 years ago. This study investigated the current scale of the problem in a large region in England, identifying the prior health care, patient characteristics, referral pattern, and outcomes of those accepted onto RRT.
Methods: Three hundred and sixty-one (88%) out of 411 patients accepted for RRT in six renal units in the South and West Region of the UK between 1 June 1996 and 31 May 1997 were studied retrospectively. We examined the history of chronic renal failure, referral path to nephrologist, management of chronic renal failure (CRF) and patient outcomes. Patients were categorized as ‘late’ if they were referred to the renal unit either within 4 months or within 1 month of requiring RRT.
Results: One hundred and twenty-four (35%) patients were referred within 4 months of RRT, and 84 (23%) within 1 month. The main differences between patients referred later and other patients was seen for those referred within 1 month. These patients were older and had more co-morbidity, significantly worse laboratory parameters at the start of RRT, were less likely to have received standard treatments for CRF, had less permanent dialysis access in place at the start of RRT (18% vs 47%, P=0.001), and had a significantly longer hospital stay (18 vs 10 days, P=0.001). Seventy-four (19%) patients died in the first 6 months: 27 (32%) in the 1-month group, 46 (16%) in all others (P=0.002). We found no evidence that patients referred late had defaulted from nephrology follow-up or had an excess of rapidly progressive disease. Though data were incomplete, there was evidence of prior CRF of over 1 year in all late referral groups.
Conclusion: Nearly a quarter of patients are referred for specialist nephrology treatment at a very late stage, within 1 month of RRT. They are less likely to receive interventions that could alter the progression of CRF or reduce its associated co-morbidity, have a worse clinical state at the start of RRT, longer hospitalization and poorer survival. These differences were much less marked for those referred within 1–4 months of starting RRT, although this is an insufficient time to prepare for RRT. Further research is needed to determine the missed opportunities for more proactive diagnosis and management of CRF.

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More information

Published date: 2002
Keywords: chronic renal failure, early intervention, end-stage renal disease, late referral, renal replacement therapy

Identifiers

Local EPrints ID: 24487
URI: http://eprints.soton.ac.uk/id/eprint/24487
ISSN: 0931-0509
PURE UUID: 94e4971d-6785-4ed6-8e9d-dfa82cdbad7b
ORCID for Paul Roderick: ORCID iD orcid.org/0000-0001-9475-6850

Catalogue record

Date deposited: 31 Mar 2006
Last modified: 09 Jan 2022 02:47

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Contributors

Author: Paul Roderick ORCID iD
Author: Chris Jones
Author: Nick Drey
Author: Sara Blakeley
Author: Premila Webster
Author: Jonathan Goddard
Author: Sue Garland
Author: Linda Bourton
Author: Juan Mason
Author: Charlie Tomson

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