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Nephrol Dial Transplant (1996) 11: 2417-2420
© 1996 European Renal Association-European Dialysis and Transplant Association

brief-report

Late diagnosis of chronic renal failure and mortality on maintenance dialysis

R. Sesso and A. G. Belasco

Division of Nephrology, Department of Medicine and Clinical Epidemiology Unit, Escola Paulista de Medicina, Universidade Federal de Sao Paulo Brazil

Correspondence and offprint requests to: Correspondence and offprint requests to: Dr Ricardo Sesso, Escola Paulista de Medicina, Division of Nephrology, Rua Botucatu 740, Sao Paulo, SP, 04023-900-Brazil

BACKGROUND.: Recent observations in our country have shown that late diagnosis of chronic renal failure (CRF) is an important cause of late referral and late commencement of maintenance dialysis. We prospectively investigated the influence of late diagnosis of CRF on patient mortality during dialysis therapy.

METHODS.: Among 184 consecutive patients with non-diabetic end-stage renal disease starting chronic dialysis at the Federal University Hospital in the city of Sao Paulo, 106 had a late diagnosis of CRF (less than 1 month before starting dialysis) and 78 had an early diagnosis. During the first 6 months of dialysis treatment, patient survival was compared in the two groups, using the Kaplan-Meier method and the Cox proportional hazards model.

RESULTS.: Six-month patient survival rate was lower in the late than in the early diagnosis group (69% versus 87%, P<0.01). In the late diagnosis group, the hazard ratio of mortality was 2.77 (95% C1, 1.36–5.66) times that of the early diagnosis group. In a multivariate analysis, after adjusting for age, comorbid illness, and serum biochemical measurements, time of diagnosis did not remain significantly associated with mortality risk. In this analysis, age, pulmonary infection, and low serum albumin were significant predictors of mortality.

CONCLUSIONS.: Patients with a late diagnosis have a higher mortality risk during the first 6 months of maintenance dialysis. This increased risk is related to comorbid conditions, some of which could be prevented by predialysis care. Interventions to promote early diagnosis of CRF and adequate predialysis follow-up need to be evaluated if the survival of patients with chronic renal failure is to improve.

Keywords: chronic renal failure; diagnosis; dialysis; mortality; treatment


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