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Perit Dial Int 28(4): 371-376
2008
© 2008 International Society for Peritoneal Dialysis
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ORIGINAL ARTICLES

IMPACT OF EARLY NEPHROLOGY REFERRAL ON MORTALITY AND HOSPITALIZATION IN PERITONEAL DIALYSIS PATIENTS

Kai Ming Chow, Cheuk Chun Szeto, Man Ching Law, Bonnie Ching-Ha Kwan, Chi Bon Leung and Philip Kam-Tao Li

Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong, SAR, China

Correspondence to: K.M. Chow, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China. Chow_Kai_Ming{at}alumni.cuhk.net

{diamondsuit} Objectives: Several studies have examined the possible association between late referral to a nephrologist and mortality on maintenance hemodialysis. However, we lack information on the benefit of early nephrologist referral in patients receiving peritoneal dialysis (PD).

{diamondsuit} Patients and Methods: In an inception cohort of 102 consecutive PD patients identified in a single center between 2003 and 2004, we sought to determine whether late nephrologist referral was associated with poor outcomes. The primary end point was all-cause mortality. The effects of early referral to a multidisciplinary low clearance clinic on cardiovascular mortality and length of hospitalization were also evaluated.

{diamondsuit} Results: Of 102 incident PD patients, 61 subjects (59.8%) were referred early to the nephrologist (more than 3 months) before dialysis initiation. During the study period of 284.9 patient-years (median follow-up period 36.8 months), 25 patients died, 12 due to cardiovascular causes. Both cardiovascular and all-cause mortality were significantly increased among PD patients with late referral, but the relationship between late referral and all-cause mortality was mitigated substantially by adjusting for relevant factors. In univariate analysis, late nephrology referral was associated with increased cardiovascular mortality, with a hazard ratio of 5.43 (95% confidence interval 1.46 – 20.21, p = 0.012). Annual adjusted days of hospitalization were similar between the early and late nephrology referral groups.

{diamondsuit} Conclusions: A comprehensive analysis of incident PD subjects confirmed the significant relationship between late nephrology referral and all-cause and cardiovascular mortality. A causal relationship remains to be established and validated.

KEY WORDS: Referral; nephrology; hospitalization; cardiovascular mortality.

Received 4 September 2007; accepted 14 November 2007.






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