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KMID : 0359920090280040286
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Korean Journal of Nephrology
2009 Volume.28 No. 4 p.286 ~ p.294
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The Impact of Timing of Nephrology Referral on Prognosis in Patients with Diabetic Chronic Kidney Disease
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Lee Dong-Young
Choi So-Young
Cho Sung-Yeon
Park Ji-Young
Lee Sang-Ho
Ihm Chun-Gyoo
Lee Tae-Won
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Abstract
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Purpose: Diabetic patients with chronic kidney disease (CKD) are associated with a significantly poorer prognosis following renal replacement therapy (RRT) in comparison to those with nondiabetic CKD. To improve such prognosis, it is crucial to achieve a timely referral to nephrologists. This article evaluated the impact the timing of nephrology referral has on prognosis in patients with diabetic CKD.
Methods: Retrospective study was conducted regarding 239 patients with diabetic CKD on RRT. Patients were grouped according to referral patterns with those referred more than 1 month prior to initiating dialysis designated as early referral (ER) group and those referred within 1 month as late referral (LR) group. Characteristics of patients and risk factors for 3-month and 1-year mortality were analyzed, and mortality rates of ER and LR groups were compared using Kaplan-Meier curves of 1-year mortality.
Results: LR group showed a significantly higher (p=0.023) 1-year mortality rate and more frequently required urgent dialysis or angiocatheter and complicated congestive heart failure (CHF), pulmonary edema. Contrarily, ER group showed a significantly lower mortality rate (p=0.0179) based on Kaplan-Meier survival curve of 1-year mortality. According to logistic regression analysis, CVD (OR=7.695) and low total cholesterol level (OR=0.979) and CVD (OR=8.021), emergent dialysis (OR=3.734), and high HbA1C level (OR=1.528) were risk factors of significance of 3-month and 1-year mortality, respectively.
Conclusion: Among diabetic patients with CKD, late-referred group was associated with a significantly higher rate of 1-year mortality. With LR as a risk factor of 1-year mortality according to univariate analysis, timing of referral is a critical prognostic factor.
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KEYWORD
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Diabetic nephropathy, Referral, Dialysis
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