{"title":"在印度北部，早期和晚期转诊到肾病专家对慢性肾病患者预后的影响。","authors":"Manoj Dhanorkar, Narayan Prasad, Ravi Kushwaha, Manas Behera, Dharmendra Bhaduaria, Monika Yaccha, Manas Patel, Anupama Kaul","doi":"10.1155/2022/4768540","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>CKD patients are often asymptomatic in the early stages and referred late to nephrologists. Late referred patients carry a poor prognosis. There is a lack of data on outcomes associated with referral patterns in CKD patients from northern India.</p><p><strong>Methods: </strong>In this observational cohort study, all CKD patients who visited the nephrology OPD of the institute between Nov 1, 2018, and Dec 31, 2020, were classified as early referral (ER) if their first encounter with a nephrologist occurred more than one year before initiation of dialysis and education about dialysis (from a nurse or nephrologist). The remaining others were considered late referrals (LRs). The outcomes impact of early and late referrals was analyzed.</p><p><strong>Results: </strong>A total of 992 (male 656) CKD patients (ER, <i>n</i> = 475 and LR, <i>n</i> = 517) were enrolled. Patients referred early were older and diabetic and had higher BMI, better education, occupation, and socioeconomic status as compared to those referred late. The mean eGFR at first contact with the nephrologist was (25.4 ± 11.5 ml/min) in ER and 9.6 ± 5.7 ml/min in the LR group and had a higher comorbidity score. The CKD-MBD parameters, hemoglobin, and nutritional parameters were worse in LR. Only a few patients had AVF, and the majority required emergency dialysis in the LR group. A total of 91 (9.2%) patients died, 17 (1.7% ER and 74 (7.5%) patients in the LR group patients. There was significantly lower survival at 6 months (ER 97.1% vs. LR 89.7%), 12 months (ER 96.4% vs. LR 85.7%), 18 months (ER 96.4% vs. LR 85.7%), and 24 months (ER 96.4% vs. LR 85.7%) in late referral group as compared to early referral group (<i>P</i>=0.005).</p><p><strong>Conclusions: </strong>LR to nephrologists has the risk of the emergency start of dialysis with temporary vascular access and had a higher risk of mortality. The timely referral to the nephrologist in the predialysis stage is associated with better survival and reduced mortality.</p>","PeriodicalId":14177,"journal":{"name":"International Journal of Nephrology","volume":"2022 ","pages":"4768540"},"PeriodicalIF":1.7000,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9177347/pdf/","citationCount":"2","resultStr":"{\"title\":\"Impact of Early versus Late Referral to Nephrologists on Outcomes of Chronic Kidney Disease Patients in Northern India.\",\"authors\":\"Manoj Dhanorkar, Narayan Prasad, Ravi Kushwaha, Manas Behera, Dharmendra Bhaduaria, Monika Yaccha, Manas Patel, Anupama Kaul\",\"doi\":\"10.1155/2022/4768540\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>CKD patients are often asymptomatic in the early stages and referred late to nephrologists. Late referred patients carry a poor prognosis. There is a lack of data on outcomes associated with referral patterns in CKD patients from northern India.</p><p><strong>Methods: </strong>In this observational cohort study, all CKD patients who visited the nephrology OPD of the institute between Nov 1, 2018, and Dec 31, 2020, were classified as early referral (ER) if their first encounter with a nephrologist occurred more than one year before initiation of dialysis and education about dialysis (from a nurse or nephrologist). The remaining others were considered late referrals (LRs). The outcomes impact of early and late referrals was analyzed.</p><p><strong>Results: </strong>A total of 992 (male 656) CKD patients (ER, <i>n</i> = 475 and LR, <i>n</i> = 517) were enrolled. Patients referred early were older and diabetic and had higher BMI, better education, occupation, and socioeconomic status as compared to those referred late. The mean eGFR at first contact with the nephrologist was (25.4 ± 11.5 ml/min) in ER and 9.6 ± 5.7 ml/min in the LR group and had a higher comorbidity score. The CKD-MBD parameters, hemoglobin, and nutritional parameters were worse in LR. Only a few patients had AVF, and the majority required emergency dialysis in the LR group. A total of 91 (9.2%) patients died, 17 (1.7% ER and 74 (7.5%) patients in the LR group patients. There was significantly lower survival at 6 months (ER 97.1% vs. LR 89.7%), 12 months (ER 96.4% vs. LR 85.7%), 18 months (ER 96.4% vs. LR 85.7%), and 24 months (ER 96.4% vs. LR 85.7%) in late referral group as compared to early referral group (<i>P</i>=0.005).</p><p><strong>Conclusions: </strong>LR to nephrologists has the risk of the emergency start of dialysis with temporary vascular access and had a higher risk of mortality. The timely referral to the nephrologist in the predialysis stage is associated with better survival and reduced mortality.</p>\",\"PeriodicalId\":14177,\"journal\":{\"name\":\"International Journal of Nephrology\",\"volume\":\"2022 \",\"pages\":\"4768540\"},\"PeriodicalIF\":1.7000,\"publicationDate\":\"2022-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9177347/pdf/\",\"citationCount\":\"2\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"International Journal of Nephrology\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1155/2022/4768540\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"UROLOGY & NEPHROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"International Journal of Nephrology","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1155/2022/4768540","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}
引用次数: 2
摘要
背景:慢性肾病患者通常在早期无症状，转诊较晚。晚期转诊患者预后较差。缺乏与印度北部CKD患者转诊模式相关的结果数据。方法:在这项观察性队列研究中，所有在2018年11月1日至2020年12月31日期间访问该研究所肾脏病科门诊的CKD患者，如果他们第一次与肾病科医生会面的时间比开始透析和透析教育(护士或肾病科医生)早一年以上，则被归类为早期转诊(ER)。其余的被认为是晚期转诊。分析早期和晚期转诊对转诊结果的影响。结果:共纳入992例(男性656例)CKD患者(ER, n = 475, LR, n = 517)。与晚期患者相比，早期患者年龄较大，患有糖尿病，具有更高的BMI，更好的教育，职业和社会经济地位。首次与肾病专家接触时，ER组的平均eGFR为(25.4±11.5 ml/min)， LR组为9.6±5.7 ml/min，合并症评分较高。LR组CKD-MBD参数、血红蛋白和营养参数更差。只有少数患者有AVF，在LR组中大多数患者需要紧急透析。共91例(9.2%)患者死亡，其中17例(1.7%)ER和74例(7.5%)LR组患者死亡。与早期转诊组相比，晚期转诊组在6个月(ER 97.1% vs LR 89.7%)、12个月(ER 96.4% vs LR 85.7%)、18个月(ER 96.4% vs LR 85.7%)和24个月(ER 96.4% vs LR 85.7%)的生存率均显著低于早期转诊组(P=0.005)。结论:肾内科医生发现的LR有紧急开始透析并有临时血管通路的风险，并且有较高的死亡率。在透析前阶段及时转诊到肾病科医师与更好的生存和降低死亡率相关。
Impact of Early versus Late Referral to Nephrologists on Outcomes of Chronic Kidney Disease Patients in Northern India.
Background: CKD patients are often asymptomatic in the early stages and referred late to nephrologists. Late referred patients carry a poor prognosis. There is a lack of data on outcomes associated with referral patterns in CKD patients from northern India.
Methods: In this observational cohort study, all CKD patients who visited the nephrology OPD of the institute between Nov 1, 2018, and Dec 31, 2020, were classified as early referral (ER) if their first encounter with a nephrologist occurred more than one year before initiation of dialysis and education about dialysis (from a nurse or nephrologist). The remaining others were considered late referrals (LRs). The outcomes impact of early and late referrals was analyzed.
Results: A total of 992 (male 656) CKD patients (ER, n = 475 and LR, n = 517) were enrolled. Patients referred early were older and diabetic and had higher BMI, better education, occupation, and socioeconomic status as compared to those referred late. The mean eGFR at first contact with the nephrologist was (25.4 ± 11.5 ml/min) in ER and 9.6 ± 5.7 ml/min in the LR group and had a higher comorbidity score. The CKD-MBD parameters, hemoglobin, and nutritional parameters were worse in LR. Only a few patients had AVF, and the majority required emergency dialysis in the LR group. A total of 91 (9.2%) patients died, 17 (1.7% ER and 74 (7.5%) patients in the LR group patients. There was significantly lower survival at 6 months (ER 97.1% vs. LR 89.7%), 12 months (ER 96.4% vs. LR 85.7%), 18 months (ER 96.4% vs. LR 85.7%), and 24 months (ER 96.4% vs. LR 85.7%) in late referral group as compared to early referral group (P=0.005).
Conclusions: LR to nephrologists has the risk of the emergency start of dialysis with temporary vascular access and had a higher risk of mortality. The timely referral to the nephrologist in the predialysis stage is associated with better survival and reduced mortality.
期刊介绍：
International Journal of Nephrology is a peer-reviewed, Open Access journal that publishes original research articles, review articles, and clinical studies focusing on the prevention, diagnosis, and management of kidney diseases and associated disorders. The journal welcomes submissions related to cell biology, developmental biology, genetics, immunology, pathology, pathophysiology of renal disease and progression, clinical nephrology, dialysis, and transplantation.
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