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Editorial Comment
Why patients with progressing kidney disease are referred late to the nephrologist: on causes and proposals for improvement
Divisions of Nephrology of the University Hospitals – 1 Bern, Switzerland, 2 Gent, Belgium, 3 Leeds, UK and 4 Heidelberg, Germany
Correspondence and offprint requests to: J.-P. Wauters, Division of Nephrology, University Hospital, 3010 Bern, Switzerland. E-mail: jean-pierre.wauters@insel.ch
Keywords: chronic kidney disease; dialysis; end-stage renal failure; improvement of patient care; late referral
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Introduction |
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The adverse effects arising from late referral (LR) have been reported by nephrologists over the past 20 years from several countries [1–10]: not only does LR delay the introduction of measures to attenuate the progressive loss of kidney function and prevent uraemic complications [11], but LR has also numerous short and long-term deleterious effects on clinical outcome [1–8]. The only study that did not confirm the long-term harmful effects of LR is the study of Roubicek et al. [12]. It appears, however, that their definition of LR was longer (4 months before dialysis), patients were younger, with less co-morbidities and relatively long hospitalization times in both patient groups, and a shorter mean survival time of the early referral group than in most other patient series.
While a recent review analyzed the relationships between LR, mortality and morbidity, and the potential positive effects
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Some facts about late referral |
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Reasons for late referral |
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Disease-related reasons
Patient-related reasons
Physician-related reasons
Primary care physician.
Nephrologist.
Dialysis centre-related.
Education and communication.
Health care system-related reasons
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Proposals to prevent late referral |
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Improved medical education and communication
The role of guidelines
An interwoven network
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Conclusions |
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