Waqar Ahmed, Aizaz Mand Ahmed, Tahir Shafi.
Referral Pattern of End Stage Kidney Failure Patients at Shaikh Zayed Hospital, Lahore.
Proceeding Shaikh Zayed Postgrad Med Comp Jan ;22(1):1-5.

The outcome in end stage kidney disease depends upon the presence of numbers and severity of complications like anemia, hypoalbumenemia, acidosis, hypertension and degree of uremia at the time of start of renal replacement therapy (RRT). It has been observed that patient who are referred early to the nephrologist have lesser number of complications, get elective vascular access, have the choice to select the mode of RR T and their survival is much better as compared to those who are referred late and require emergency dialysis. In the present study, out of total 210 patients who were admitted for dialysis, only 46 (22%) were under the care of nephrologist. Their mean hemoglobin was 8.2gm/dl, Blood Urea Nitrogen (BUN) 121 mg/di, serum creatinine l 4.67mg/dl and serum Bicarbonate was 10.92meq/1. Systolic blood pressure was less than 140mmHg in only 20 patients (10%) and diastolic blood pressure was less than 90mmHg in only 23 patients (11%). Only 14 patients (6.7%) had already created arterio venous fistula on hospitalization. One hundred and eighteen patients (56%) had fluid over load, 93 patients (44%) had Hyperkalemia, 96 patients (46%) had metabolic acidosis and 71 patients (34%) had uremic encephalopathy. Presence of these complications in such large number of patients and other bad prognostic factors as low mean hemoglobin, sever uremia, sever metabolic acidosis and hyperkalemia at the time of start of RRT indicates poor pre ESRD management in our patient and signifies the need for early referral of renal failure patients to Nephrologist.

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