The Impact of Timing of Nephrology Referral on Prognosis in Patients with Diabetic Chronic Kidney Disease

Lee, Dong Young; Choi, So Young; Cho, Sung Yeon; Park, Ji Young; Lee, Sang Ho; Ihm, Chun Gyoo; Lee, Tae Won

Abstract

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.