Impact of Early Nephrology Referral on Factors Correlated with Hemodialysis Patients' Survival

Kang, Woo Heon; Oh, Ha Young; Shin, You Jung; Seol, Jeongsook; Kang, Moonja; Tak, Eun Young; Lee, Nam Sun; Lee, Mikyoung; Ryu, Rosa; Song, Young Hyea; Huh, Wooseong; Kim, Yoon Goo; Kim, Dae Joong

Abstract

BACKGOUND: The late referral to nephrologist was founded as independent risk factor of poor survival in hemodialysis patients. Patients referred lately are prone to initiate dialysis urgently through temporary catheter and the use of catheter increase the incidence of catheter related complications. But patients' survival may be influenced by multiple and more complex factors beside referral pattern and use of catheter. So we planed to evaluate the effect of referral pattern on patients' survival and related factors.
METHODS
This analysis included 629 incident hemodialysis patients in single center. Demographical, clinical, laboratory data were collected retrospectively. Early referral was defined as first nephrology visit over 3 months prior to initiation of dialysis. Clinical characteristics were compared between early (ER) and late referral groups (LR). Survival analysis and Cox models were performed to assess the relationship of referral pattern and mortality. Significant differences were defined as p value less than 0.05.
RESULTS
ER included 269 patients and their mean age, male proportion were not different from those of LR. In ER, pre-dialysis education program and nutritional counseling were offered much more than LR and lesser catheter usage, higher serum albumin at the initiation of dialysis. ER survived longer but in Cox models, only older age, presence of diabetes, lower serum albumin at the initiation of dialysis were independent risk factor for death (odds ratio 1.047, 1.547, 0.615, respectively)
CONCLUSION
Although early referral decrease catheter use at the initiation and urgent hemodialysis, classical risk factors such as old age, presence of diabetes, nutritional status at the initiation are more important in patients prognosis.