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Nephrol Dial Transplant (2000) 15: 147-149
© 2000 European Renal Association-European Dialysis and Transplant Association

Editorial Comments

Early referral and selection of peritoneal dialysis as a treatment modality

Jose A. Diaz-Buxo

Fresenius Medical Care, Charlotte, NC, USA

Correspondence and offprint requests to: Jose A. Diaz-Buxo, Fresenius Medical Care, 1051 East Morehead Street, Suite 250, Charlotte, NC 28204, USA.

Keywords: early referral; early start; modality selection; pre-ESRD education

The time of patient referral to a nephrologist in relation to residual renal function (RRF) is an important topic of discussion due to its potential impact on clinical outcome and total cost of renal replacement therapy to society. The present discussion is intended to outline the interrelation between early referral to a nephrologist, selection of dialytic modality, clinical outcomes and economic impact. Intuitively, we are prone to assume that early referral has beneficial medical and economic impact. Several recent studies also support this thesis.

The available evidence strongly suggests that early referral can improve the short- and long-term survival of uraemic patients; facilitate the management of comorbid conditions; provide the time necessary for patient education, creation of dialytic access and appropriate initiation of dialysis; help preserve adequate nutrition and biochemical parameters; reduce hospitalizations; and influence the selection of dialysis modality. . . . [Full Text of this Article]

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