The need for early nephrology referral

Abstract

The incidence of end-stage renal disease is increasing. Progression to end stage can be slowed if kidney damage is detected at an early stage. Prognosis and outcomes in patients with chronic kidney disease have been related to the quality of predialysis care and the timing of referral. Many patients with chronic kidney disease are referred to a nephrologist close to commencement of renal replacement therapy. This leads to suboptimal management of complications of chronic renal insufficiency, and increased morbidity and mortality of patients on renal replacement therapy. This article addresses the evidence that examines the view that patients need to be referred early in order to avoid complications of chronic renal insufficiency. Early referral can be achieved through improved communication between primary health care givers and nephrology services. A multidisciplinary approach has a significant impact on outcomes. In the face of rising incidence of chronic kidney disease, early referral of all patients is not possible. Therefore, identification of patients at risk for rapid deterioration of renal function is important in order to rationalize and reduce health care expenditure.

Perception of Indications for Nephrology Referral among Internal Medicine Residents

“…Timing of referral of patients with CKD by their primary care physician to the nephrologist affects patients' prognosis and clinical outcomes (13)(14)(15). The prevalence of late referral, defined as first nephrology visit within 1 month of initiation of dialysis, has been found to range from 25% to 46% (16,17).…”

Improving the Management of Chronic Kidney Disease in Uruguay: A National Renal Healthcare Program

“…Nephrologists cannot care for all CKD patients, and the prevention and early detection of this disease requires a skilled, multidisciplinary primary care team and a coordinated approach [11]. In order to attain such care, different strategies have been published based on the healthcare system and the living standards of various countries [12,13,14,15,16,17,18,19,20,21,22,23,24,25]. …”

Análisis descriptivo de la consulta externa de nefrología pediátrica en el Hospital Universitario Hernando Moncaleano Perdoma de Neiva

“…En nuestros resultados, podemos darnos cuenta que la patología renal afecta muy frecuentemente a los niños menores de 5 años, predominando ligeramente en el género femenino, datos que si son comparados con la literatura disponible, son concordantes con la población en general (4) . Además, es muy gratificante, darnos cuenta como el servicio de Nefrología Pediátrica, ha logrado gran cobertura en todos y cada uno de los municipios del departamento e incluso en departamentos y países vecinos.…”