We studied all new patients accepted for renal replacement therapy (RRT) in one unit from 1/1/96 to 31/12/97 (n=198), to establish time from nephrology referral to RRT, evidence of renal disease prior to referral and the adequacy of renal management prior to referral.
Sixty four (32.3%, late referral group) required RRT within 12 weeks of referral.
Fifty-nine (29.8%) had recognizable signs of chronic renal failure>26 weeks prior to referral.
Patients starting RRT soon after referral were hospitalized for significantly longer on starting RRT (RRT within 12 weeks of referral, median hospitalization 25.0 days (n=64) ; RRT>12 weeks after referral, median 9.7 days (n=126), (p<0.001)). Observed survival at 1 year was 68.3% overall, with 1-year survival of the late referral and early referral groups being 60.5% and 72.5%, respectively (p=NS).
Hypertension was found in 159 patients (80.3%) :
46 (28.9%) were started on antihypertensive medication following referral, while a further 28 (17.6%) were started on additional antihypertensives.
Of the diabetic population (n=78), only 26 (33.3%) were on an angiotensin-converting-enzyme inhibitor (ACEI) at referral.
Many patients are referred late for dialysis despite early signs of renal failure, and the pre-referral management of many of the patients, as evidenced by the treatment of hypertension and use of ACEI in diabetics, is less than optimal.
Mots-clés Pascal : Insuffisance rénale, Royaume Uni, Europe, Homme, Traitement substitutif, Hémodialyse, Prévention, Surveillance sanitaire, Appareil urinaire pathologie, Rein pathologie
Mots-clés Pascal anglais : Renal failure, United Kingdom, Europe, Human, Replacement therapy, Hemodialysis, Prevention, Sanitary surveillance, Urinary system disease, Kidney disease
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 99-0005457
Code Inist : 002B30A03B. Création : 31/05/1999.