Waqar H Kazmi, Gregorio T Obrador, Samina S Khan, Brian J G Pereira, Annamaria T Kausz.
Late Nephrology referral and mortality among patients with end-stage renal disease.
Med Channel Jan ;13(2):7-10.

BACKGROUND: Late nephrology referral has been associated with adverse outcomes among patients with end-stage renal disease (ESRD), however, its relationship to mortality is unclear We examined the impact of timing of nephrology care relative to initiation of dialysis on mortality after initiation of dialysis. METHODS: Data from the Dialysis Morbidity and Mortality Study (DMMS) Wave II, a prospective study of incident dialysis patients, were used. Late referral (LR) was defined as first nephrology visit < 4 months, early referral (ER) as first nephrology visit 4 months prior to initiation of dialysis. A Cox proportional hazards model was built to examine the association between timing of nephrology referral and mortality. . RESULTS: The cohort was comprised of 2195 patients; 54% were males, 66% were Caucasians, 26% were African-Americans and 33% were referred late. A Cox proportional hazards analysis demonstrated that compared to ER patients, LR patients had a 45% higher risk of death at one year after initiation of dialysis (HR= 1.45; 95% CI 1.12, 1.88). CONCLUSION: Among patients with chronic kidney disease (CKD) who initiated dialysis, LR- was associated with higher risk of death at one year after initiation of dialysis compared to ER.

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