Why patients with progressing kidney disease are referred late to the nephrologist: on causes and proposals for improvement

Wauters, J.‐P.; Lameire, Norbert; Davison, A. M.; Ritz, Eberhard

doi:10.1093/ndt/gfh709

Cited by 63 publications

(64 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Logistic regression was used in cross-sectional analyses to determine factors associated with prior nephrology contact adjusted for demographic and clinical factors chosen based on prior literature. [22][23][24] In longitudinal analyses, Cox proportional hazards models were used to examine the association of prior nephrology contact and outcomes. For the outcomes of CKD progression and incident CVD, death was treated as a censoring event.…”

Section: Discussionmentioning

confidence: 99%

Influence of Nephrologist Care on Management and Outcomes in Adults with Chronic Kidney Disease

et al. 2015

View full text Add to dashboard Cite

BACKGROUND: Predialysis nephrology care for adults with late stage chronic kidney disease (CKD) is associated with improved outcomes. Less is known about the effects of nephrology care in earlier stages of CKD. OBJECTIVE: We aimed to evaluate the effect of nephrology care on management of CKD risk factors and complications, CKD progression, incident cardiovascular disease (CVD), and death. DESIGN: This was a prospective cohort study. PARTICIPANTS: Participants included 3855 men and women aged 21 to 74 years enrolled in the Chronic Renal Insufficiency Cohort (CRIC) Study with a mean (SD) estimated glomerular filtration rate (eGFR) at entry of 45 (17) ml/min/1.73 m 2 , followed for a median of 6.6 years. MAIN MEASURES: The main predictor was self-reported prior contact with a nephrologist at study enrollment. Outcomes evaluated included CKD progression (≥ 50 % eGFR loss or end-stage renal disease), incident CVD, and death. RESULTS: Two-thirds (67 %) of the participants reported prior contact with a nephrologist at study enrollment. They were younger, more likely to be male, non-Hispanic white, and had lower eGFR and higher urine protein (p < 0.05). A subgroup with eGFR 30-< 60 ml/min/1.73 m 2 and prior contact with a nephrologist were more likely to receive pharmacologic treatment for CKD-related complications and to report angiotensin-converting enzyme inhibitor or angiotensin receptor blocker (ACEi/ARB) use. After propensity score matching (for reporting prior contact with a nephrologist vs. not) and adjusting for demographic and clinical variables, prior contact with a nephrologist was not significantly associated with CKD progression, incident CVD or death (p > 0.05). CONCLUSIONS: One-third of CRIC participants had not seen a nephrologist before enrollment, and this prior contact was subject to age, sex, and ethnic-related disparities. While prior nephrology care was associated with more frequent treatment of CKD complications and use of ACEi/ARB medications, there was neither an association between this care and achievement of guidelinerecommended intermediate measures, nor long-term adverse outcomes.

show abstract

Section: Discussionmentioning

confidence: 99%

Influence of Nephrologist Care on Management and Outcomes in Adults with Chronic Kidney Disease

et al. 2015

View full text Add to dashboard Cite

show abstract

“…The reasons for late referral may be patient related or physician related. Psychologic factors such as denial of the need for dialysis, advanced age, and low socioeconomic status with poor access to care may lead to late referral (20). In addition to the inadequate training perceived by physicians as mentioned earlier, failure to appreciate the benefit of early nephrologist care, the asymptomatic nature of CKD, and clinical inertia might be other plausible causes (11,21).…”

Section: Discussionmentioning

confidence: 99%

Perception of Indications for Nephrology Referral among Internal Medicine Residents

Agrawal

Ghosh

Barnes

et al. 2009

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

“…Overall, such disease-related causes do not account for more than 15-20% of the presently observed late referral cases. 354 …”

Section: Disease Relatedmentioning

confidence: 99%

Early referral strategies for management of people with markers of renal disease: a systematic review of the evidence of clinical effectiveness, cost-effectiveness and economic analysis

Black

Sharma²,

Scotland³

et al. 2010

Health Technol Assess

178

144

View full text Add to dashboard Cite

How to obtain copies of this and other HTA programme reports An electronic version of this title, in Adobe Acrobat format, is available for downloading free of charge for personal use from the HTA website (www.hta.ac.uk). A fully searchable DVD is also available (see below).Printed copies of HTA journal series issues cost £20 each (post and packing free in the UK) to both public and private sector purchasers from our despatch agents.Non-UK purchasers will have to pay a small fee for post and packing. For European countries the cost is £2 per issue and for the rest of the world £3 per issue. How to order:-fax (with credit card details) -post (with credit card details or cheque) -phone during office hours (credit card only).Additionally the HTA website allows you to either print out your order or download a blank order form. Contact details are as follows:Synergie UK (HTA Department) Digital House, The Loddon Centre Wade Road Basingstoke Hants RG24 8QW Email: orders@hta.ac.uk Tel: 0845 812 4000 -ask for 'HTA Payment Services' (out-of-hours answer-phone service) Fax: 0845 812 4001 -put 'HTA Order' on the fax header Payment methods Paying by chequeIf you pay by cheque, the cheque must be in pounds sterling, made payable to University of Southampton and drawn on a bank with a UK address. Paying by credit cardYou can order using your credit card by phone, fax or post. SubscriptionsNHS libraries can subscribe free of charge. Public libraries can subscribe at a reduced cost of £100 for each volume (normally comprising 40-50 titles). The commercial subscription rate is £400 per volume (addresses within the UK) and £600 per volume (addresses outside the UK). Please see our website for details. Subscriptions can be purchased only for the current or forthcoming volume. How do I get a copy of HTA on DVD?Please use the form on the HTA website (www.hta.ac.uk/htacd/index.shtml). HTA on DVD is currently free of charge worldwide.The website also provides information about the HTA programme and lists the membership of the various committees. HTA NIHR Health Technology Assessment programmeT he Health Technology Assessment (HTA) programme, part of the National Institute for Health Research (NIHR), was set up in 1993. It produces high-quality research information on the effectiveness, costs and broader impact of health technologies for those who use, manage and provide care in the NHS. 'Health technologies' are broadly defined as all interventions used to promote health, prevent and treat disease, and improve rehabilitation and long-term care.The research findings from the HTA programme directly influence decision-making bodies such as the National Institute for Health and Clinical Excellence (NICE) and the National Screening Committee (NSC). HTA findings also help to improve the quality of clinical practice in the NHS indirectly in that they form a key component of the 'National Knowledge Service'. The HTA programme is needs led in that it fills gaps in the evidence needed by the NHS. There are three routes to the start of projects...

show abstract

Why patients with progressing kidney disease are referred late to the nephrologist: on causes and proposals for improvement

Cited by 63 publications

References 39 publications

Influence of Nephrologist Care on Management and Outcomes in Adults with Chronic Kidney Disease

Influence of Nephrologist Care on Management and Outcomes in Adults with Chronic Kidney Disease

Perception of Indications for Nephrology Referral among Internal Medicine Residents

Early referral strategies for management of people with markers of renal disease: a systematic review of the evidence of clinical effectiveness, cost-effectiveness and economic analysis

Contact Info

Product

Resources

About