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Late referral for dialysis: improving the management of chronic renal disease

Record type: Article

Background: Timely nephrological referral of patients with chronic renal failure (CRF) is important, but referral at a late stage of disease is common.
Aim: To investigate whether late referral of patients is avoidable, and where the missed opportunities lie.
Design: Prospective ascertainment of new cases and comprehensive review of pre-end stage history.
Methods: Patients admitted to Bristol and Portsmouth renal units for chronic RRT between June 1997 and May 1998 were identified from computer databases. Data were collected from case notes and hospital records, and a self-administered patient questionnaire. Late referral, defined as dialysis within 4 months of first referral to a dialysing nephrologist, was categorized by algorithm as unavoidable or avoidable.
Results: Of 250 patients, 96 (38%) were referred late. Forty-three (45%) had definite avoidable reasons: 35 (37%) with raised serum creatinine for a median 3.7 years (IQR 1.5–8.2) before referral, and eight (8%) with risk factors for renal disease but scant assessment of renal function; 12/43 (31%) had a diagnosis of diabetic nephropathy. Late referred patients were less likely to receive standard renal therapies for chronic renal failure, were in a poorer clinical state at start of RRT, and more often required emergency dialysis, compared to patients referred early. Late referrals were as likely from a hospital as a primary care physician.
Discussion: A significant proportion of patients are avoidably referred to a dialysing renal unit at a very late stage. Guidelines on referral should be developed by nephrologists, primary and secondary care physicians, and patient groups, and further research is needed into the cost-effectiveness of early referral strategies.

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Citation

Roderick, P., Jones, C., Tomson, C. and Mason, J. (2002) Late referral for dialysis: improving the management of chronic renal disease QJM: An International Journal of Medicine, 95, (6), pp. 363-370. (doi:10.1093/qjmed/95.6.363).

More information

Published date: 2002

Identifiers

Local EPrints ID: 24488
URI: http://eprints.soton.ac.uk/id/eprint/24488
ISSN: 1460-2725
PURE UUID: 1e82db06-c071-46bb-bf76-62f9ec27d7e1
ORCID for P. Roderick: ORCID iD orcid.org/0000-0001-9475-6850

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Date deposited: 31 Mar 2006
Last modified: 17 Jul 2017 16:13

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Contributors

Author: P. Roderick ORCID iD
Author: C. Jones
Author: C. Tomson
Author: J. Mason

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