Effect of Early Nephrology Referral on the Initiation of Hemodialysis and Survival in Patients With Chronic Kidney Disease and Cardiovascular Diseases

Abstract

Background The timing of referral to nephrologists is highly variable in patients with chronic kidney disease (CKD). The impact of early referral on the timing of hemodialysis (HD) and mortality in the patients with CKD and cardiovascular diseases (CVD) was evaluated in this present study. Methods and Results A total of 366 patients with CKD and CVD began HD at the National Cardiovascular Center between 1983 and 2003, and survival was followed until 2005. The times between the first evaluation by a nephrologist and the date of the first HD were categorized as late (LR <6 months) or early (ER ≥6 months) referral. Patients were classified into the ER (n=194) and LR (n=172) groups. Clinical data and renal function were not different. In the LR group, the renal function declined more rapidly and the duration between the first visit to the hospital and the first HD was shorter than the ER group. The survival rate after the initiation of HD was better in the ER group. Age, pre end-stage renal disease therapy and cardiac function had a significant impact on survival. Conclusions Early nephrology referral is important and necessary for for patients with CKD and CVD in terms of a better renal prognosis and survival. (Circ J 2007; 71: 511 - 516)