Early nephrology care provided by the nephrologist alone is not sufficient to mitigate the social and psychological aspects of chronic kidney disease

Abstract

OBJECTIVE:Patients with chronic kidney disease who receive early nephrology care have a better prognosis with maintenance dialysis. We aimed to determine whether early referral to a nephrologist can also improve the psychological burden of having chronic kidney disease.SUBJECTS AND METHODS:Thirty‐nine patients with chronic kidney disease that required hemodialysis were studied: 19 had a ≥ 6-month history of nephrology care (Group1), and 20 had never received any prior nephrology care (Group2). All patients participated in a semi‐structured interview that addressed their perceived knowledge and psychological aspects related to CKD and hemodialysis. Demographic and laboratory data as well as socioeconomic status were evaluated.RESULTS:In both groups, most of the patients were of low socioeconomic status. Group 1 had significantly better laboratory parameters (p<0.05). The patients' answers to the questions showed no differences between the groups: 63% of Group 1 and 55% of Group 2 reported that they had no prior knowledge about dialysis; 58% and 40%, respectively, reported that they “don't completely understand what the doctor says”; and 74% and 85%, respectively, believed that their “kidneys would work again”.CONCLUSION:Pre‐dialysis nephrology care improves the clinical conditions of the patients with chronic kidney disease but is insufficient for minimizing other aspects of having chronic kidney disease.

Perception of health-related quality of life in children with chronic kidney disease by the patients and their caregivers: Multicentre national study results

“…We did not find any effect of the duration of nephrological care on HRQoL. This is consistent with the observations of other authors who demonstrated that although early nephrological care improves the clinical condition of CKD patients, it is not sufficient to minimize the psychosocial aspects resulting from kidney disease [ 6 ].…”

Influencia de la consulta de enfermería de enfermedad renal crónica avanzada en pacientes que inician tratamiento renal sustitutivo

“…Esto puede ser debido a que de los 3 hospitales de referencia de nuestra provincia, con atención nefrológica especializada, uno de ellos no cuenta con consulta de enfermería, y en otro, la enfermera solo dispone de un día a la semana, en el que desarrolla consulta propia de educación enfermera, dedicando el resto de días a apoyar a la consulta médica. Estudios recientes indican que la atención aportada exclusivamente por nefrólogos es insuficiente para mitigar aspectos sociales y psicológicos del paciente con ERC, los pacientes atribuyen esto al poco tiempo dedicado por los nefrólogos en la consulta y al lenguaje que utilizan (36) .…”

Unexpected Return for Follow-up During the First Year of Multidisciplinary Care May Be Predictive of Rapid Deterioration of Renal Function

“…In particular, late referral to nephrologists is associated with poor outcomes and increased mortality and morbidity, 4 – 6 whereas early referral to nephrology departments allows sufficient predialysis education, which can delay the initiation of dialysis and improve mortality rates. 7 , 8 However, predialysis nephrology care fails to decrease the social impact of CKD, 9 and a cooperative intervention with nephrologist-based multidisciplinary care (MDC) was developed to improve positive attitudes for disease management among patients with CKD. This level of care has a substantial influence on mortality and morbidity and delays entry into hemodialysis.…”