Skip Navigation



NDT Advance Access published online on December 8, 2005
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfi313
This Article
Right arrow FREE Full Text (PDF) Freely available
Right arrow All Versions of this Article:
21/4/957    most recent
gfi313v2
gfi313v1
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Jander, A.
Right arrow Articles by Zwolinska, D.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Jander, A.
Right arrow Articles by Zwolinska, D.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

© The Author [2005]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For permissions please email: journals.permissions@oxfordjournals.org
Received March 13, 2005
Accepted November 11, 2005

Original Article

Does a late referral to a nephrologist constitute a problem in children starting renal replacement therapy in Poland? - a nationwide study

Anna Jander 1, Michael Nowicki 1, Marcin Tkaczyk 1, Maria Roszkowska-Blaim 2, Tomasz Jarmolinski 3, Ewa Marczak 4, Ewa Paluba 5, Pietrzyk A Jacek 6, Grzegorz Siten 7, Roman Stankiewicz 8, Krystyna Szprynger 9, Maria Zajaczkowska 10, J. Zachwieja 11, W. Zoch-Zwierz 12, and D. Zwolinska 13 *

1 Department of Nephrology and Dialysis, Polish Mother's Memorial Hospital Research Institute Tódz and Pediatric Nephrology Centre, Poland
2 Department of Nephrology and Dialysis, Polish Mother's Memorial Hospital Research Institute Tódz and Pediatric Nephrology Centre, Warszawa, Poland
3 Department of Nephrology and Dialysis, Polish Mother's Memorial Hospital Research Institute Tódz and Pediatric Nephrology Centre, Szczecin, Poland
4 Department of Nephrology and Dialysis, Polish Mother's Memorial Hospital Research Institute Tódz and Pediatric Nephrology Centre, Gdansk, Poland
5 Department of Nephrology and Dialysis, Polish Mother's Memorial Hospital Research Institute Tódz and Pediatric Nephrology Centre, Sandomierz, Poland
6 Department of Nephrology and Dialysis, Polish Mother's Memorial Hospital Research Institute Tódz and Pediatric Nephrology Centre, Kraków, Poland
7 Department of Nephrology and Dialysis, Polish Mother's Memorial Hospital Research Institute Tódz and Pediatric Nephrology Centre, Rzeszów, Poland
8 Department of Nephrology and Dialysis, Polish Mother's Memorial Hospital Research Institute Tódz and Pediatric Nephrology Centre, Torun, Poland
9 Department of Nephrology and Dialysis, Polish Mother's Memorial Hospital Research Institute Tódz and Pediatric Nephrology Centre, Zabrze, Poland
10 Department of Nephrology and Dialysis, Polish Mother's Memorial Hospital Research Institute Tódz and Pediatric Nephrology Centre, Lublin, Poland
11 Department of Nephrology and Dialysis, Polish Mother's Memorial Hospital Research Institute Tódz and Pediatric Nephrology Centre, Poznan, Poland
12 Department of Nephrology and Dialysis, Polish Mother's Memorial Hospital Research Institute Tódz and Pediatric Nephrology Centre, Bialystok, Poland
13 Department of Nephrology and Dialysis, Polish Mother's Memorial Hospital Research Institute Tódz and Pediatric Nephrology Centre, Wroclaw, Poland

* To whom correspondence should be addressed.
D. Zwolinska, E-mail: Email: nefro{at}wp.pl



  Abstract

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.
Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?


This article has been cited by other articles:


Home page
 NDT PlusHome page
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]


Disclaimer: Please note that abstracts for content published before 1996 were created through digital scanning and may therefore not exactly replicate the text of the original print issues. All efforts have been made to ensure accuracy, but the Publisher will not be held responsible for any remaining inaccuracies. If you require any further clarification, please contact our Customer Services Department.