Outcomes of Early versus Late Nephrology Referral in Chronic Kidney Disease: A Systematic Review
The American Journal of MedicinePublished 19 October 2011
Neil A. Smart, Thomas Titus
Citations292
SJR quartileQ1
SJR score1.00
SNIP1.04
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TL;DR
Results show reduced mortality and hospitalization, better uptake of peritoneal dialysis, and earlier placement of arteriovenous fistula for hemodialysis with early nephrology referral.
Abstract
Our analyses show reduced mortality and hospitalization, better uptake of peritoneal dialysis, and earlier placement of arteriovenous fistula for hemodialysis with early nephrology referral.
Keywords
Medicine
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Timing of referral emerged to be a significant factor impacting homogeneity in the mortality outcome and results suggest significantly higher mortality and increased early hospitalization of chronic kidney disease subjects referred late to nephrologists as compared with earlier referred subjects.
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The fundamental impact of anemia on organ function is reduced oxygen delivery to tissues, but other consequences such as impaired cognitive function and concentration, sleep disorders, altered hemostasis, depressed immune function, and impaired cardiac function are not uncommon.
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It is concluded that late referral to a nephrologist is still a major problem that has a negative influence on modality choice for peritoneal dialysis, and on morbidity and mortality of ESRD patients.
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Age, pre end-stage renal disease therapy and cardiac function had a significant impact on survival and early nephrology referral is important and necessary for patients with CKD and CVD in terms of a better renal prognosis and survival.
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This study strengthens the previously reported association between late referral of ESRF patients and subsequent poor survival on dialysis and Delays in the referral to renal specialist services of patients with advanced chronic renal failure should be minimised.
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