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Late referral to a nephrologist reduces access to renal transplantation

Cass, Alan, Cunningham, Joan, Snelling, Paul L. and Ayanian, J. Z. (2003). Late referral to a nephrologist reduces access to renal transplantation. American journal of kidney diseases,42(5):1043-1049.

Document type: Journal Article
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Title Late referral to a nephrologist reduces access to renal transplantation
Author Cass, Alan
Cunningham, Joan
Snelling, Paul L.
Ayanian, J. Z.
Journal Name American journal of kidney diseases
Publication Date 2003
Volume Number 42
Issue Number 5
ISSN 0272-6386   (check CDU catalogue open catalogue search in new window)
Start Page 1043
End Page 1049
Total Pages 7
Place of Publication United States
Publisher W.B. Saunders Co.
Language English
Field of Research 1103 - Clinical Sciences
HERDC Category C1 - Journal Article (DEST)
Abstract BACKGROUND: Primary care physicians frequently request consultation with a nephrologist late in the treatment of patients with chronic kidney disease (CKD). Between 25% and 40% of referred CKD patients need renal replacement therapy (RRT) within 3 months of referral to a nephrologist. Late referral is associated with higher morbidity and worse long-term survival rates. The authors examined the effect of late referral on access to renal transplantation.

METHODS: Data from the Australian end-stage renal disease (ESRD) registry (Australia and New Zealand Dialysis and Transplant Registry Database [ANZDATA]) regarding all ESRD patients aged 18 to 64, starting treatment between April 1995 and December 1998 were used. Excluding overseas visitors and patients commencing RRT outside Australia, the data encompassed 3,310 patients. Main outcome measures were: (1) acceptance onto a waiting list, (2) receipt of a transplant before March 31, 2000, and/or (3) receipt of a transplant during defined periods of RRT.

RESULTS: Late referral patients were less likely to be put on the waiting list (odds ratio [OR], 0.49; 95% confidence intervals [CI], 0.41 to 0.59) or given a transplant (hazard ratio, 0.65; 95% CI, 0.55 to 0.77). Transplantation rates differed maximally during the first 3 months of RRT (OR, 0.21; 95% CI, 0.11 to 0.40) and were lower throughout RRT (OR in the period more than 2 years after commencing RRT, 0.67; 95% CI, 0.47 to 0.96).

CONCLUSION: Primary care physicians should refer patients at risk for ESRD earlier than is current practice. To improve access to transplantation and to achieve optimal outcomes of ESRD management, greater collaboration will be needed between primary care physicians and nephrologists.
Keywords Kidney Failure,Chronic
Kidney Transplantation
DOI   (check subscription with CDU E-Gateway service for CDU Staff and Students  check subscription with CDU E-Gateway in new window)
Additional Notes 2678 (Journal) DA - 20031028IS - 1523-6838LA - engPT - Journal ArticleSB - IM
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Created: Mon, 17 Dec 2007, 09:02:11 CST