Improvement in Clinical Outcome by Early Nephrology Referral in Type Ii Diabetics on Maintenance Peritoneal Dialysis

← Objectives

To evaluate the influence of early nephrology referral on clinical outcome in type II diabetes mellitus patients on maintenance peritoneal dialysis (PD).

← Design

This is a retrospective study in a single University Hospital in Taiwan.

← Patients

This study analyzed the type II diabetic patients entering our PD program from February 1988 to June 2000. Patients that were presented to a nephrologist more than 6 months before starting dialysis were defined as early referrals (ER). Patients were considered late referrals (LR) if they were transferred to the nephrology department within 6 months before initial dialysis.

← Main Outcome Measures

Patient survival and technique survival curves were derived from Kaplan–Meier analysis and were compared using the Cox–Mantel log rank test. Covariates were analyzed with Cox proportional hazards model.

← Results

52 type II diabetic patients were enrolled in this study: 16 in the ER group and 36 in the LR group. Patient survival was better in the ER group than in the LR group {relative risks [exp(coef)] 0.42; 95% confidence interval 0.152 – 0.666; p < 0.05}. The improved survival in the ER group was independent of age at dialysis, good glycemic control, and residual renal function, as indicated in the multivariate analysis with stepwise regression by Cox proportional hazards model. The ER group was also associated with better technique survival.

← Conclusions

These results suggest that early nephrology referral before initiating dialysis is associated with improved long-term clinical outcome in type II diabetics on maintenance PD.

Early referral as an independent predictor of clinical outcome in end-stage renal disease on hemodialysis and continuous ambulatory peritoneal dialysis

OBJECTIVES

To evaluate the influence of early nephrology referral on clinical outcome in patients on maintenance hemodialysis (HD) and peritoneal dialysis (PD).

PATIENTS AND METHODS

This study retrospectively analyzed patients entering our HD and PD program from February 2000 to June 2003. Patients who presented to a nephrologist more than 6 months before starting dialysis were defined as early referral (ER). Meanwhile, patients transferred to the nephrology department less than 6 months before initial dialysis were considered late referral (LR). RESULTS HD GROUPS: Of 78 HD patients, 37 (47.1%) qualified for the ER group and 41 (52.6%) were designated to the LR group. The demographic data were analyzed for both the HD and PD groups. No significant differences in average age at dialysis, duration of hemodialysis, and gender were noted between these two groups. The same applied for the biochemical parameters in both groups. HD patients with early referral had significantly better survival (p < .05) as plotted with the Kaplan-Meier method. In univariate analysis by cox proportional hazards mode, the early referral in HD patients [Exp (Coef) = 0.426, P < .01] significantly influenced survival. The various variables were further examined by multivariate analysis, and early referral, hemoglobin, and age still significantly impacted patient survival (P < .05). CAPD GROUPS: The survival curve related to early referral in continuous ambulatory peritoneal dialysis (CADP) patient survival rate was significantly higher for the early referral groups (P < .05). In addition, a multivariate analysis adjusting for several potential risk factors found that referral time remained significantly associated with patient survival. In additional, hemoglobin and age were significant and independent predictors of mortality.

CONCLUSION

This study demonstrates that time between referral and starting dialysis is a predictor of survival for both HD and PD patients, with early referral being associated with longer survival time. These analytical results suggest that early referral before dialysis is important in determining long-term prognosis in HD and PD patients.

Improvement of clinical outcome by early nephrology referral in type II diabetics on hemodialysis

OBJECTIVES

To evaluate the influence of early nephrology referral on clinical outcome in type II diabetes mellitus patients on maintenance hemodialysis dialysis.

PATIENTS AND METHODS

This study retrospectively analyzed the type II diabetic patients entering our PD program from February 1988 to June 2001. Patients who were presented to a nephrologist more than 6 months before starting dialysis were defined as early referral (ER). Patients were considered late referral (LR) if they were transferred to the nephrology department within 6 months before initial dialysis.

RESULTS

Hundred and fifteen type II diabetic patients receiving HD for at least 3 months were enrolled in this study. Sixteen of the 53 patients (46.1%) were in the ER group and 62 of the 115 (53.9%) were in the LR group. In univariate analysis by Cox proportional hazards mode, the early referral (Exp (Coef) = 0.423, p < 0.01), good glycemic control (Exp (Coef) = 0.16, p < 0.05), and age at dialysis (Exp (Coef) = 1.026, p < 0.05 (had significantly influenced the patient survival. The residual renal function in the ER group, estimated by creatinine clearance (Ccr), significantly exceeded that of the LR group (ER vs. LR: 4.46 +/- 1.56 vs. 2.51 +/- 1.70 mL/min, p < 0.001). The patients with early referral had significantly better survival (p < 0.05). Five-year survival improved significantly in the early referral group compared to the late referral group (ER: 72.4%; LR: 35.2%, p < 0.05).

CONCLUSIONS

We demonstrate that the time of referral before starting dialysis is a predictor of survival for type II diabetics on HD. Patients with early referral are associated with longer survival. The beneficial effect might be associated with the timely initiation of the chronic HD program. These results suggest that early referral before dialysis is important in determining the long-term prognosis in type II diabetics on HD.