Study shows 34% of English dialysis patients are referred late, 67% of them have to be treated as an emergency

Late referral to a nephrologist is still a big problem. A retrospective cohort study of 3,928 incident dialysis patients in the English National Health Service showed that 34% of the patients had not been referred to a kidney care specialist 90 days before they had to start dialysis. Furthermore, the study group of Ian Blunt found out that 49% of the patients who had been referred late, had had regular contact with other hospital services before. This means that the chronic kidney disease had not been detected or, at least, had been dramatically underestimated by the general practitioners or doctors of other sub-specialties.

This is an alarming result, as Prof. Carmine Zoccali, NDT Editor-in-Chief, comments: "With chronic kidney disease, a common comorbidity such as diabetes or hypertension, kidney function declines slowly, but continuously - often without any symptoms. However we now have data that shows how an early referral into nephrologic care can slow the progression of the disease and could save a patient from being dependent on dialysis for several month or even years; besides, this would save the health care systems high costs."

Furthermore the study also shows that this late referral can involve a series of medical complication: 67% of the patients who had not seen a nephrologist 90 days before they started dialysis, received their first dialysis as an emergency kind of treatment. The illness came as a shock to the patient who had to cope with the fact to be dependent on dialysis for the rest of their lives from one day to the next.

C. Zoccali points out: "Late referral is not only an English problem, it is common in nearly all European countries. It means that our patients have no chance to undergo preventive measures and improve their outcomes. Therefore ERA-EDTA is fighting for a higher awareness among the general population, but also our colleagues of other medical specialties, of chronic kidney disease. The study of Blunt et al. has shown once again that it is high time to improve the prevention and early detection of chronic kidney disease."