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Nephrology Dialysis Transplantation 2004 19(9):2175-2180; doi:10.1093/ndt/gfh409
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Nephrol Dial Transplant Vol. 19 No. 9 © ERA-EDTA 2004; all rights reserved

Editorial Comment

The deadly risk of late referral

Roel M. Huisman

Department of Internal Medicine, Division of Nephrology, University Hospital Groningen, The Netherlands

Keywords: chronic kidney disease; dialysis; late referral; mortality; predialysis

The first 150 words of the full text of this article appear below.



   Introduction
 
In the last few years, studies have appeared that finally provide conclusive evidence that adequate predialysis care improves survival. The recent evidence comes from large-scale cohort studies, which constitutes not the highest level of scientific evidence but the next best. Clearly the best possible evidence, a randomized study of early vs late referral, will be ethically inadmissible so the next best level is the one we will have to accept as the best possible evidence. This relative certainty is new but the idea itself is not: timely referral to a nephrologist of patients with chronic renal failure has been suggested for many years to improve outcome [1]. Although this was common knowledge, at least among nephrologists, the evidence so far was not flawless, since it was based mainly on retrospective, single centre studies with their intrinsic bias. Some of these studies had not been able to find a . . . [Full Text of this Article]



   Benefits of early referral
 


   Incidence of late referral
 


   Patient-related factors associated with late referral
 


   What causes the positive effects of early referral?
 


   Conclusion
 

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