NDT Advance Access originally published online on December 8, 2005
Nephrology Dialysis Transplantation 2006 21(4):957-961; doi:10.1093/ndt/gfi313
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
© The Author [2005]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
Original Articles: Clinical Nephrology
Does a late referral to a nephrologist constitute a problem in children starting renal replacement therapy in Poland? – a nationwide study
Nowicki1
ski3uba57
czkowska10ska13
1 Department of Nephrology and Dialysis, Polish Mother's Memorial Hospital Research Institute, Tód
and Pediatric Nephrology Centres in 2 Warszawa, 3 Szczecin, 4 Gdask, 5 Sandomierz, 6 Kraków, 7 Rzeszów, 8 Toru, 9 Zabrze, 10 Lublin, 11 Pozna, 12 Biaystok, 13 Wrocaw, Poland
Correspondence and offprint requests to: Prof. Dr Michea Nowicki, Department of Nephrology and Dialysis, Polish Mother's Memorial Hospital Research Institute and Pediatric Nephrology Center, Poland. Email: nefro{at}wp.pl
Background. It is estimated that 20–50% of adult patients start chronic dialysis therapy without prior contact with a nephrologist. The aim of this nationwide study was to assess clinical and metabolic status of children at the start of chronic dialysis in Poland with regard to the timing of the referral to a nephrologist.
Methods. We studied data of 180 children (mean age 14±6 years) undergoing chronic dialysis in 13 (out of 14) dialysis pediatric centres in Poland. Patients were classified as early referrals (ERs) when they entered the dialysis programme at least 1 month after the first referral to a nephrologist or late referrals (LRs) when the dialysis was introduced within 1 month from the first visit.
Results. Seventy-nine percent of pediatric patients were referred early (ER) to the dialysis centre and 21% were referred late (LR) and had to start dialysis within a month. When starting dialysis, LR patients had significantly higher levels of urea and phosphate as well as lower calcium and haemoglobin in comparison with ERs. Hypertension, pulmonary oedema, fluid overload, treatment in the intensive care unit (ICU) and body mass index (BMI) below 10th percentile turned out to be more frequent in the LR group. Peritoneal dialysis (PD) was used as the first method of dialysis in 59% of ERs and 46% of LRs. The majority of ER patients was treated in the predialysis period with calcitriol, phosphate binders and low protein diet (84%, 89%, 92% of all children, respectively), and 20% of them received epoetin. In the up to 3 years observation of our initial cohort, we also found that the patients who were referred late were less likely to receive kidney transplant (P = 0.02).
Conclusion. The results of the study indicate that the LR to a pediatric nephrologist was associated with poorer clinical and metabolic status of children entering chronic dialysis programmes.
Keywords: children; chronic renal failure; dialysis; late referral; pre-dialysis care
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  G. Baer, N. Lameire, and W. Van Biesen Late referral of patients with end-stage renal disease: an in-depth review and suggestions for further actions NDT Plus, April 29, 2009; (2009) sfp050v1. [Abstract] [Full Text] [PDF]
|
|