Early referral to a nephrologist is associated with better outcomes in type 2 diabetes patients with end-stage renal disease

Summary Objective End-stage renal disease (ESRD) requiring renal replacement therapy (RRT) is a late complication of type 2 diabetes. The correlation between pre-ESRD medical care and outcome has been rarely studied in France. Methods Community-based study of case-incident ESRD patients. Medical care practices were described retrospectively when starting RRT. Medical status, mortality, morbidity, and quality-of-life were recorded prospectively. Results One hundred and fourty-eight ESRD patients with type 2 diabetes were included. Factors independently correlated with mortality within 3 months of RRT onset were presence of physical impairment of ambulation at onset of RRT [odd ratio (OR): 5, (95%CI: 1.9-13.3)], and starting RRT in life-threatening circumstances [OR: 3.6, (95%CI: 1.2-10.7)]. Factors independently correlated with "poor outcome" 1 year after the onset of RRT were BMI less than 20 kg/m 2 [OR: 13.4, (95 %CI: 1.5-120.2)] and presence of 2 [OR: 2.7, (95 %CI: 0.9-8.4)], or 3 or more comorbid conditions [OR: 4, (95% CI: 1.4-11)]. Three months after the first RRT session, survival was 16.4% better for patients who had had regular nephrological care versus none , and 9.1% better for those who had had late nephrological care versus none . Type 2 diabetes patients starting RRT in an emergency setting had had significant less regular nephrological care. Length of their first hospital stay was significantly longer. They were more likely to have lower residual renal function, gastrointestinal symptoms, lower serum albumin, lower hematocrit, lower serum calcium, and higher serum phosphorus. Conclusions During the course of chronic renal failure in type 2 diabetes patients, early implementation of nephrological well-established guidelines is associated with better outcome after starting RRT.