Early referral and its impact on emergent first dialyses, health care costs, and outcome.
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
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 98-0398377
Code Inist : 002B27B03. Création : 25/01/1999.