Nephrol Dial Transplant (2002) 17: 371-375
© 2002 European Renal Association-European Dialysis and Transplant Association
Editorial Comments
Late referral: loss of chance for the patient, loss of money for society
Department of Nephrology, Necker Hospital, Paris, France
Introduction
Despite all efforts to alert the medical community about its multiple detrimental consequences, late nephrological referral of renal patients still remains a frequent problem in all countries. Recent studies show that up to 40% of patients suffering from chronic renal insufficiency (CRI) begin renal replacement therapy (RRT) less than 6 months after being referred to a renal unit, without having benefited from early nephrological care in the predialysis period [1–11]. This situation is most unfortunate as substantial advances have been made in the management of CRI patients. Late referred patients do not benefit from such progress, especially from the renoprotective and cardioprotective strategies that constitute the basis of optimal therapy of CRI patients today [12–16].
Renoprotection (i.e. use of dietary and pharmacological measures aimed at halting or at least slowing progression of renal failure), is currently considered a fundamental goal in the
Loss of chance for the patient
Loss of chance of avoiding ESRD and the need for RRT
Loss of chance of benefiting from optimal renoprotective treatment
Loss of chance of benefiting from adequate cardioprotective treatment
Loss of chance of benefiting from adequate preparation for RRT and preservation of quality of life
Loss of money for the society
Direct overcosts
Indirect overcosts
Conclusion
Notes
References
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