Late referral for end-stage renal disease: a region-wide survey in the south west of England

Roderick, Paul; Jones, Chris; Drey, Nicholas; Blakeley, Sara; Webster, Premila; Goddard, Jonathan; Garland, Sue; Bourton, Linda; Mason, Juan C.; Tomson, Charles

doi:10.1093/ndt/17.7.1252

Cited by 128 publications

(142 citation statements)

References 13 publications

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“…Guidelines for vascular access placement (13) might have created unintended consequences; after the access is ready for use, providers may have lower thresholds for initiating dialysis. Many retrospective cohort studies have suggested a survival benefit during the first 1 year of dialysis for patients who receive predialysis nephrology care and patients who initiate dialysis with an arteriovenous fistula or graft (13)(14)(15)(16)(17)(18)(19)(20)(21)(22). Analyses that evaluate the influence of predialysis nephrology care and dialysis access at initiation on outcomes may suffer from lead time bias; nephrologists may accelerate dialysis start dates for well-prepared patients under their care, and survival analyses that begin with dialysis initiation may show better survival in well-prepared patients.…”

Section: Discussionmentioning

confidence: 99%

Provider and Care Characteristics Associated with Timing of Dialysis Initiation

Slinin

Guo

et al. 2014

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives There is a trend in the United States to maintenance dialysis initiation at higher levels of estimated GFR. This study aimed to determine whether provider characteristics and pre-ESRD nephrology care and vascular access are independently associated with higher estimated GFR at initiation.Design, setting, participants, & measurements This retrospective cohort study used US Renal Data System data for patients who initiated dialysis in 2006 (n=83,621) and American Medical Association Physician Master File data for provider characteristics. Patient characteristics and estimated GFR were defined, and providers at dialysis initiation were identified. Earlier dialysis initiation was defined as initiation at estimated GFR.10 ml/min per 1.73 m 2 . Nephrologist density per 100 ESRD patients was calculated by Health Service Area in 2006. Associations between provider characteristics and estimated GFR were determined using logistic regression and linear regression models, accounting for provider clustering.Results Of the cohort, 47.8% of patients initiated dialysis at estimated GFR.10 ml/min per 1.73 m 2 , and 16.2% of patients initiated dialysis at estimated GFR$15 ml/min per 1.73 m 2 . Predialysis nephrologist care for 0-12 months was associated with greater odds of earlier initiation compared with no care. Patients initiating with an arteriovenous fistula or graft were more likely to initiate earlier than patients initiating with a catheter. Provider sex was not associated with timing of dialysis initiation as measured by estimated GFR. Care by providers who graduated from nondomestic medical schools was associated with greater odds of earlier initiation. Greater provider experience was associated with lower likelihood of earlier initiation. ConclusionThis study supports the hypothesis that provider factors are associated with timing of dialysis initiation in the United States.

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Section: Discussionmentioning

confidence: 99%

Provider and Care Characteristics Associated with Timing of Dialysis Initiation

Slinin

Guo

et al. 2014

Clinical Journal of the American Society of Nephrology

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“…LR in adults is common with estimates of between 20% and 50% (10)(11)(12)(13)(14)(15), and has been shown to adversely affect dialysis access (3,7,9), hemoglobin levels (3,4,9), and choice of modality at the start of RRT (3,5,8), as well as being associated with poorer survival (4,5,7,9) and prolonged hospital stay (8). LR will also delay listing for transplantation as work-up is delayed and reduce the chance of pre-emptive transplantation (16,17).…”

Section: Introductionmentioning

confidence: 99%

Early Requirement for RRT in Children at Presentation in the United Kingdom: Association with Transplantation and Survival

Pruthi

Casula

Inward

et al. 2016

CJASN

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Background and objectives We evaluated rates and factors associating with late referral (LR) and describe association of LR with access to renal transplantation and patient survival in children in the United Kingdom. Early requirement of RRT within 90 days of presentation to a pediatric nephrologist was classed as a LR, and those .90 days as an early referral (ER).Design, setting, participants, & measurements We included patients who commenced RRT, aged $3 months and ,16 years, from 1996 to 2012.Results Of 1603 patients, 25.5% (n=408) were LR, of which 75% commenced RRT in ,30 days following presentation. Those with LR were more likely to be older at presentation, female, and black. The primary renal disease in LR was more likely to be glomerular disease (odds ratio [OR], 1.6; 95% confidence interval [95% CI], 1.12 to 2.29), renal malignancy and associated diseases (OR, 4.11; 95% CI, 1.57 to 10.72), tubulo-interstitial diseases (OR, 2.37; 95% CI, 1.49 to 3.78), or an uncertain renal etiology (OR, 5.75; 95% CI, 3.1 to 10.65). Significant differences in rates of transplantation between LR and ER remained up to 1-year following commencement of dialysis (21% versus 61%, P,0.001) but with no differences for donor source (33.3% and 35.3% living donor in LR and ER respectively, P=0.55). The median (interquartile range) follow-up time was 4.8 years (2.9-7.6). There were 55 deaths with no statistically significant difference in survival in the LR group compared with the ER group (hazard ratio, 1.30; 95% CI, 0.7 to 2.3; P=0.40).Conclusions We found that 25% of children starting RRT in the United Kingdom receive a LR to pediatric renal services, with little change observed over the past two decades. Those with LR are unable to benefit from preemptive transplantation and require longer periods of dialysis before transplantation. There is an urgent need to understand causes of avoidable LR and develop strategies to improve kidney awareness more widely among health care professionals looking after children.

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“…Awareness of CKD remains unacceptably low, despite recent attempts to increase awareness through dissemination of clinical practice guidelines and recommendations for patients with CKD or its risk factors to providers [20][21][22], including community awareness events such as World Kidney Day [23,24]. Earlier recognition of CKD can slow the progression of CKD, prevent complications, and reduce cardiovascular-related outcomes; additionally, early referral to a nephrologist has been shown to improve outcomes for those who progress to end-stage renal disease [27][28][29][30]. It has been observed that physicians other than nephrologists are less …”

Section: Introductionmentioning

confidence: 99%

Doctors’ knowledge and practices regarding chronic kidney disease at a tertiary care hospital

et al. 2016

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Background: The complications of chronic kidney disease (CKD) significantly contribute to morbidity and mortality, therefore clinical practice guidelines have been developed to facilitate early detection and treatment. However, given the high prevalence of CKD, many patients with early CKD are seen by non-nephrologists, who need to be aware of CKD complications, screening methods and treatments goals in order to initiate timely therapy and referral.Methods: This was a cross-sectional study conducted at three campuses of the Ziauddin University Hospital, Karachi, Pakistan in 2016. A questionnaire based survey was conducted to assess the knowledge and practices of doctors from various specialties regarding CKD.Results: We performed a questionnaire based survey to assess knowledge and practice patterns in CKD care among 156 doctors. There were 63 male and 50 female respondents. There were 24 attending doctors, 73 post-graduate trainees and 25 house-officers. Our data showed that although CKD risk factors are generally recognized, there is a paucity of knowledge regarding CKD management guidelines and staging of CKD. There is an awareness regarding timely referral to nephrology, but many would still not refer at the appropriate stage. Many also do not use standard equations to calculate Glomerular Filtration rate (GFR) and Creatinine Clearance]. Most do screen for diabetic nephropathy, know about ACE-I/ARBs and provide dietary counseling to CKD patients. The majority do not read medical journals to keep their knowledge up-to-date. Junior doctors (post-graduate trainees and house-officers) fared better than attending doctors in the knowledge and practice parameters.

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Late referral for end-stage renal disease: a region-wide survey in the south west of England

Cited by 128 publications

References 13 publications

Provider and Care Characteristics Associated with Timing of Dialysis Initiation

Provider and Care Characteristics Associated with Timing of Dialysis Initiation

Early Requirement for RRT in Children at Presentation in the United Kingdom: Association with Transplantation and Survival

Doctors’ knowledge and practices regarding chronic kidney disease at a tertiary care hospital

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