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Timing of nephrology referral: a study of its effects on the likelihood of transplantation and impact on mortality

Cass, Alan, Snelling, Paul L., Cunningham, Joan, Wang, Zhiqiang and Hoy, Wendy (2002). Timing of nephrology referral: a study of its effects on the likelihood of transplantation and impact on mortality. Nephrology,7(S1):S29-S32.

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Title Timing of nephrology referral: a study of its effects on the likelihood of transplantation and impact on mortality
Author Cass, Alan
Snelling, Paul L.
Cunningham, Joan
Wang, Zhiqiang
Hoy, Wendy
Journal Name Nephrology
Publication Date 2002
Volume Number 7
Issue Number S1
ISSN 1440-1797   (check CDU catalogue  open catalogue search in new window)
Start Page S29
End Page S32
Total Pages 4
Place of Publication Carlton
Publisher Wiley-Blackwell Publishing Asia
Language English
Field of Research 320000 Medical and Health Sciences
Abstract Delayed referral of patients with end-stage renal disease (ESRD) to a nephrologist is associated with considerable early morbidity and increased mortality. The Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) has collected data regarding the timing of referral to a nephrologist for all patients beginning renal replacement therapy (RRT) since 1 April 1995. We examined survival and likelihood of transplantation for patients who started RRT between 1 April 1995 and 31 December 1998, with follow-up until 31 March 2000 (up to 5 years follow-up). Of 4886 patients starting RRT, 1277 (26.1%) were in the late referral (LR) group and 3609 (73.9%) were not (NLR). In a multivariate analysis, predictors of LR were age 0–44 years and the presence of two or more comorbidities. Ninety days after referral, 60% of patients in the LR group were on haemodialysis compared with 55% of patients in the NLR group; 40% of patients in each group were receiving peritoneal dialysis at this time. Patients in the LR group were significantly less likely to receive a transplant in the first year after referral and throughout the duration of the study compared with the NLR group. Mortality rates were 19 and 13 persons per 100 patient years in the LR and NLR groups, respectively. In conclusion, delayed referral to a nephrologist was associated with increased mortality which continued for up to 5 years, even after adjustment for known predictors of mortality including age, sex, comorbidities and primary renal disease.
Keywords Mortality
nephrology
transplantation
DOI http://dx.doi.org/10.1046/j.1440-1797.7.s.15.x   (check subscription with CDU E-Gateway service for CDU Staff and Students  check subscription with CDU E-Gateway in new window)
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