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  1. Early referral and its impact on emergent first dialyses, health care costs, and outcome.

    Article - En anglais

    Early referral (ER) to nephrologists of patients with chronic renal failure was assessed for its impact on the incidence of emergent first dialyses and choice of dialysis modality (hemodialysis [HD] or peritoneal dialysis [PD]), and survival.

    We reviewed events preceding first dialyses of 238 patients with end-stage renal disease (ESRD) starting dialysis between January 1990 and April 1997, with follow-up extending through November 1997.

    Patients referred more than 1 month before needing dialysis (early referral [ER]) were compared with patients presenting within 30 days of needing dialysis (late referral [LR]). The need for emergent HD was significantly less among ER (29%) as compared with LR (90%) (P<0.0001).

    Initial modality chosen was similar among ER patients (59% for HD v 41% for PD), a finding that contrasts with national percentages, which approximate 85% and 15%, respectively.

    Whereas most patients had not changed modality at 4 months, significantly more had changed from HD to PD (36 of 160 or 23%) than from PD to HD (7 of 78 or 9%) (P<0.0001).

    Despite starting out on HD, ER and LR patients were amenable to ultimately changing to PD.

    ER and LR groups had similar numbers of Medicaid patients and patients living 1 hour or more distant to tertiary medical care.

    Furthermore, no difference was observed in the incidence of emergent HD when ER and LR living more than 1 hour away were compared. (...)

    Mots-clés Pascal : Centre orientation, Etats Unis, Amérique du Nord, Amérique, Dialyse, Indication, Technique, Temps attente, Consultation, Corrélation, Rapport coût bénéfice, Pronostic, Néphrologie

    Mots-clés Pascal anglais : Referral center, United States, North America, America, Dialysis, Indication, Technique, Waiting time, Consultation, Correlation, Cost benefit ratio, Prognosis

    Logo du centre Notice produite par :
    Inist-CNRS - Institut de l'Information Scientifique et Technique

    Cote : 98-0398377

    Code Inist : 002B27B03. Création : 25/01/1999.