Early Nephrology Referral 6 Months Before Dialysis Initiation Can Reduce Early Death But Does Not Improve Long-Term Cardiovascular Outcome on Dialysis

Hayashi, Terumasa; Kimura, Tomonori; Yasuda, Keiko; Sasaki, Koichi; Obi, Yoshitsugu; Nagayama, Harumi; Ohno, Motoki; Uematsu, Kazusei; Tamai, Tetsuro; Nishide, Takahiro; Rakugi, Hiromi; Isaka, Yoshitaka

doi:10.1253/circj.cj-15-1013

Cited by 9 publications

(8 citation statements)

References 26 publications

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“…In addition, studies have also demonstrated that time to ESKD was significantly longer in people referred early than those seen late (232,234,235,(239)(240)(241)(242), hypothesized due to the greater use of reninangiotensin system inhibitors and erythropoiesis stimulating agents, and better control of blood pressure. A systematic review confirmed similar findings in people with DKD, where early referral to nephrology services was associated with a reduction in the decline in kidney function (3.4 ml/min/1.73m 2 ) compared to those seen later (12 ml/min/1.73m 2 ).…”

Section: Key Informationmentioning

confidence: 99%

“…Most of the studies define the timing of referral with respect to months before the initiation of dialysis and unfortunately, no RCTs have been performed to investigate the effects of the timing of nephrology referral on the clinical outcomes of individuals with DKD, with recommendations based solely on observational studies. Despite the marked variability in the definitions of early and late referrals, studies conducted in Asia‐Pacific countries demonstrated that all‐cause mortality was consistently greater in people referred later to a nephrology service, in part due to the higher utility of temporary catheter‐based vascular access (231‐235). Furthermore, three systematic reviews including both DKD and NDKD, suggested favourable outcomes with an earlier referral to a nephrology service (236‐238).…”

Section: Chapter 5: Diabetic Kidney Disease and Kidney Replacement Thmentioning

confidence: 99%

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Asian Pacific Society of Nephrology Clinical Practice Guideline on Diabetic Kidney Disease

et al. 2020

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The International Diabetes Federation (IDF) estimated that 425 million people were living with diabetes mellitus (DM) in 2017 (1), which had far exceeded what was originally predicted in 2003 (333 million people by 2025). Consequently, the IDF provided a new projection of a near doubling of 629 million people with DM in 2045, with 4 out of 5 people with DM living in low-and middle-income countries (LMICs), majority from South East Asia (82 million) and the Western Pacific (159 million) regions. The increasing prevalence of DM has contributed to the growing burden of ESKD, and it is estimated that DKD is responsible for about 50% of ESKD in the developed world (2). The global burden of DKD and ESKD has a major impact on healthcare costs and resources; making screening, early detection and preventive treatment important strategies to mitigate this worldwide pandemic.

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Section: Key Informationmentioning

confidence: 99%

Section: Chapter 5: Diabetic Kidney Disease and Kidney Replacement Thmentioning

confidence: 99%

Asian Pacific Society of Nephrology Clinical Practice Guideline on Diabetic Kidney Disease

et al. 2020

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“…The definition of LR is not unified. Time frames for LRs differ significantly in numerous publications, most often this group includes patients referred to the nephrologist less than 3 months prior to starting of the dialysis [ 6–9 ] – although a much longer time frame is given, e.g., up to 6 months [ 10 ] and even up to 1 year [ 11 ]. On the other hand, the introduction of term ultralate is also suggested – up to 3 months [ 11 ] or even up to 1 month [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…[ 18 ] reported that some patients received no medical care at all. The frequency of LR reported in the literature is very diverse: 80% [ 4 ], 60.3% [ 6 ], 57.3% [ 10 ], 41% [ 8 ], 37.6% [ 11 ], 34% [ 7 ], 33% [ 19 ], and 24.1% [ 3 ] and in general studied groups are relatively small.…”

Section: Discussionmentioning

confidence: 99%

Lack or insufficient predialysis nephrology care worsens the outcomes in dialyzed patients – call for action

Miłkowski¹,

Prystacki²,

Marcinkowski³

et al. 2022

Renal Failure

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The phenomenon of patients with advanced renal failure accepted for dialysis at a late stage in the disease process (late referral [LR]) is known almost from the beginning of dialysis therapy. It may also be associated with worse outcomes. The aim of the study was to assess the effect of referral time on the outcomes, such as number of hospitalizations, length of stay, kidney transplantation, and mortality. A study of 1303 patients with end-stage renal failure admitted for dialysis in the same period in Fresenius Nephrocare Poland dialysis centers was initiated. The type of vascular access during the first dialysis was accepted as the criterion differentiating LR ( n = 457 with acute catheter) from early referral (ER; n = 846). The primary endpoint was the occurrence of death during the 13-month observation. By the end of observation, 341 (26.2%) of patients died. The frequency of death was 18.1 for ER and 37.9 for LR per 1000 patient-months. It can be estimated that 52.1% (95% CI: 40.5–61.5%) of the 341 deaths were caused by belonging to the LR group. Patients from LR group had longer hospitalizations, more malignancies, lower rate of vascular access in the form of a–v fistula, higher comorbidity index. It seems that establishing a nephrological registry would help to improve the organization of care for patients with kidney disease, particularly in the pandemic era.

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“…Early referral affords the opportunity to discuss KRT options, establish vascular or peritoneal access, enable use of appropriate treatment of uremic complications and can reduce mortality. 74,75 Identified barriers to early referral in developed countries include older age, non-black non-Caucasian race, the absence of comorbidities such as diabetes, coronary artery disease and hypertension, and initial CKD care by a general internist rather than by a general practitioner. 76 The role these barriers play in LMICs, and the presence of additional barriers unique to LMICs, remain difficult to ascertain due to the paucity of registry data.…”

Section: Referral To a Nephrologist And Timing Of Renal Replacement Tmentioning

confidence: 99%

<p>Current Management Strategies of Chronic Kidney Disease in Resource-Limited Countries</p>

Ameh¹,

Ekrikpo²,

Bello³

et al. 2020

IJNRD

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The incidence and prevalence of chronic kidney disease (CKD) and kidney failure continues to increase worldwide, especially in resource-limited countries. Many countries in this category already have a massive burden of communicable diseases, as well as socioeconomic and socio-demographic challenges. The rising CKD burden and exorbitant economic cost associated with treatment are mainly responsible for the alarming mortality rate associated with kidney disease in these regions. There is often poor risk factor (diabetes and hypertension) and CKD awareness in these countries and limited availability and affordability of treatment options. Given these observations, early disease detection and preventive measures remain the best options for disease management in resource-limited settings. Primary, secondary and tertiary preventive strategies need to be enhanced and should particularly include measures to increase awareness, regular assessment to detect hypertension, diabetes and albuminuria, options for early referral of identified patients to a nephrologist and options for conservative kidney management where kidney replacement therapies may not be available or indicated. Much is still needed to be done by governments in these regions, especially regarding healthcare funding, improving the primary healthcare systems and enhancing non-communicable disease detection and treatment programs as these will have effects on kidney care in these regions.

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Early Nephrology Referral 6 Months Before Dialysis Initiation Can Reduce Early Death But Does Not Improve Long-Term Cardiovascular Outcome on Dialysis

Cited by 9 publications

References 26 publications

Asian Pacific Society of Nephrology Clinical Practice Guideline on Diabetic Kidney Disease

Asian Pacific Society of Nephrology Clinical Practice Guideline on Diabetic Kidney Disease

Lack or insufficient predialysis nephrology care worsens the outcomes in dialyzed patients – call for action

<p>Current Management Strategies of Chronic Kidney Disease in Resource-Limited Countries</p>

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