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Factors Affecting the Referral Time to Nephrologists in Patients With Chronic Kidney Disease: A Prospective Cohort Study in Korea

Timely referral to nephrologists is important for improving clinical outcomes and reducing costs during transition periods. We evaluated the impact of patients’ demographic, clinical, and social health characteristics on referral time. A total of 1744 CKD patients who started maintaining dialysis we...

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Autores principales: Lee, Jeonghwan, Lee, Jung Pyo, An, Jung Nam, Kim, Sung Gyun, Kim, Yong-Lim, Yang, Chul Woo, Kang, Shin-Wook, Kim, Nam-Ho, Kim, Yon Su, Oh, Yun Kuy, Lim, Chun Soo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer Health 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4902530/
https://www.ncbi.nlm.nih.gov/pubmed/27175688
http://dx.doi.org/10.1097/MD.0000000000003648
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author Lee, Jeonghwan
Lee, Jung Pyo
An, Jung Nam
Kim, Sung Gyun
Kim, Yong-Lim
Yang, Chul Woo
Kang, Shin-Wook
Kim, Nam-Ho
Kim, Yon Su
Oh, Yun Kuy
Lim, Chun Soo
author_facet Lee, Jeonghwan
Lee, Jung Pyo
An, Jung Nam
Kim, Sung Gyun
Kim, Yong-Lim
Yang, Chul Woo
Kang, Shin-Wook
Kim, Nam-Ho
Kim, Yon Su
Oh, Yun Kuy
Lim, Chun Soo
author_sort Lee, Jeonghwan
collection PubMed
description Timely referral to nephrologists is important for improving clinical outcomes and reducing costs during transition periods. We evaluated the impact of patients’ demographic, clinical, and social health characteristics on referral time. A total of 1744 CKD patients who started maintaining dialysis were enrolled in a Korean prospective cohort. The early referral (ER) and late referral group (LR) were defined as patients who were referred to a nephrologist more than or less than 1 year prior to dialysis initiation, respectively. A total of 1088 patients (62.3%) were in the ER, and 656 patients (37.6%) were in the LR. Among the patients in the LR, 398 patients (60.7%) were referred within the 3 months prior to the start of dialysis (ultralate referral group [ULR]). The ER was younger at the time of referral than the LR; however, the ER was older at the start of dialysis. Patients with diabetes or hypertension as the cause of kidney disease were more common in the LR, whereas patients with glomerulonephritis, females, and nonsmokers were more common in the ER. The ER had more well-controlled blood pressure, lower phosphorus levels, and higher hemoglobin levels at the start of dialysis. Congestive heart failure (CHF) was more common in the LR. In the multivariate analysis, male sex (odds ratio [OR] 1.465, 95% confidence interval [CI] 1.034–2.076), underlying kidney disease (diabetes mellitus [OR 1.507, 95% CI 1.057–2.148] and hypertension [OR 1.995, 95% CI 1.305–3.051]), occupation (mechanician [OR 2.975, 95% CI 1.445–6.125], laborer [OR 3.209, 95% CI 1.405–7.327], and farmer [OR 5.147, 95% CI 2.217–11.953]), CHF (OR 2.152, 95% CI 1.543–3.000), and ambulatory status (assisted-walks, OR 2.072, 95% CI 1.381–3.111) were proved as the independent risk factor for late referral. Patients with hypertensive or diabetic kidney disease are referred later than those with glomerulonephritis. Male patients with physically active occupations exhibiting CHF and restricted ambulation were associated with a late referral. Considering the various factors associated with late referral, efforts to increase early referrals should be emphasized, particularly in patients with hypertension, diabetes, or congestive heart failure.
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spelling pubmed-49025302016-06-27 Factors Affecting the Referral Time to Nephrologists in Patients With Chronic Kidney Disease: A Prospective Cohort Study in Korea Lee, Jeonghwan Lee, Jung Pyo An, Jung Nam Kim, Sung Gyun Kim, Yong-Lim Yang, Chul Woo Kang, Shin-Wook Kim, Nam-Ho Kim, Yon Su Oh, Yun Kuy Lim, Chun Soo Medicine (Baltimore) 5200 Timely referral to nephrologists is important for improving clinical outcomes and reducing costs during transition periods. We evaluated the impact of patients’ demographic, clinical, and social health characteristics on referral time. A total of 1744 CKD patients who started maintaining dialysis were enrolled in a Korean prospective cohort. The early referral (ER) and late referral group (LR) were defined as patients who were referred to a nephrologist more than or less than 1 year prior to dialysis initiation, respectively. A total of 1088 patients (62.3%) were in the ER, and 656 patients (37.6%) were in the LR. Among the patients in the LR, 398 patients (60.7%) were referred within the 3 months prior to the start of dialysis (ultralate referral group [ULR]). The ER was younger at the time of referral than the LR; however, the ER was older at the start of dialysis. Patients with diabetes or hypertension as the cause of kidney disease were more common in the LR, whereas patients with glomerulonephritis, females, and nonsmokers were more common in the ER. The ER had more well-controlled blood pressure, lower phosphorus levels, and higher hemoglobin levels at the start of dialysis. Congestive heart failure (CHF) was more common in the LR. In the multivariate analysis, male sex (odds ratio [OR] 1.465, 95% confidence interval [CI] 1.034–2.076), underlying kidney disease (diabetes mellitus [OR 1.507, 95% CI 1.057–2.148] and hypertension [OR 1.995, 95% CI 1.305–3.051]), occupation (mechanician [OR 2.975, 95% CI 1.445–6.125], laborer [OR 3.209, 95% CI 1.405–7.327], and farmer [OR 5.147, 95% CI 2.217–11.953]), CHF (OR 2.152, 95% CI 1.543–3.000), and ambulatory status (assisted-walks, OR 2.072, 95% CI 1.381–3.111) were proved as the independent risk factor for late referral. Patients with hypertensive or diabetic kidney disease are referred later than those with glomerulonephritis. Male patients with physically active occupations exhibiting CHF and restricted ambulation were associated with a late referral. Considering the various factors associated with late referral, efforts to increase early referrals should be emphasized, particularly in patients with hypertension, diabetes, or congestive heart failure. Wolters Kluwer Health 2016-05-13 /pmc/articles/PMC4902530/ /pubmed/27175688 http://dx.doi.org/10.1097/MD.0000000000003648 Text en Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved. http://creativecommons.org/licenses/by/4.0 This is an open access article distributed under the Creative Commons Attribution License 4.0, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0
spellingShingle 5200
Lee, Jeonghwan
Lee, Jung Pyo
An, Jung Nam
Kim, Sung Gyun
Kim, Yong-Lim
Yang, Chul Woo
Kang, Shin-Wook
Kim, Nam-Ho
Kim, Yon Su
Oh, Yun Kuy
Lim, Chun Soo
Factors Affecting the Referral Time to Nephrologists in Patients With Chronic Kidney Disease: A Prospective Cohort Study in Korea
title Factors Affecting the Referral Time to Nephrologists in Patients With Chronic Kidney Disease: A Prospective Cohort Study in Korea
title_full Factors Affecting the Referral Time to Nephrologists in Patients With Chronic Kidney Disease: A Prospective Cohort Study in Korea
title_fullStr Factors Affecting the Referral Time to Nephrologists in Patients With Chronic Kidney Disease: A Prospective Cohort Study in Korea
title_full_unstemmed Factors Affecting the Referral Time to Nephrologists in Patients With Chronic Kidney Disease: A Prospective Cohort Study in Korea
title_short Factors Affecting the Referral Time to Nephrologists in Patients With Chronic Kidney Disease: A Prospective Cohort Study in Korea
title_sort factors affecting the referral time to nephrologists in patients with chronic kidney disease: a prospective cohort study in korea
topic 5200
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4902530/
https://www.ncbi.nlm.nih.gov/pubmed/27175688
http://dx.doi.org/10.1097/MD.0000000000003648
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