Prevalencia, factores de riesgo y consecuencias de la referencia tardía al nefrólogo

BACKGROUND Late referral of patients with chronic kidney disease (CKD) to specialized care by the nephrologist is associated with worse patient outcomes while on dialysis. OBJECTIVES To determine the prevalence, risk factors, and consequences of late nephrology referral at a Mexican tertiary care hospital. MATERIAL AND METHODS Retrospective chart review of all adult patients who began chronic hemodialysis between 2002 and 2006 at the National Institute of Cardiology "Ignacio Chavez" (NICICh), Mexico City. Timing of referral to Nephrology Department was classified as early, late or very late if the time elapsed between referral and initiation of dialysis was or = 6 months, respectively. Socio-demographic, clinical, laboratory and echocardiographic characteristics were compared according to timing of referral. RESULTS Eighty four out of 150 patients were included in the analysis. Of these, 56% were referred < 1 month, and an additional 15% between 1-6 months prior to the initiation of chronic hemodialysis. In univariate analysis, being referred by a relative or friend was associated with a higher risk (p = 0.04), and being employed with a lower risk of late referral (p = 0.05). Late referred patients were more likely to require emergency dialysis and hospitalization, and of not having a permanent vascular access for their first dialysis. They also had a higher prevalence of severe anemia (hematocrit < 28%) and of residual kidney function (estimated glomerular filtration rate < 5 mL/min/1.73 m2), as well as increased left ventricular mass. CONCLUSIONS Late nephrology referral is highly prevalent in our population and is associated with markers of suboptimal predialysis care at the onset of chronic dialysis.