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Timing of Evaluation by Specialists for Patients with Chronic Kidney Disease FREE

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The summary below is from the full report titled “The Timing of Specialist Evaluation in Chronic Kidney Disease and Mortality.” It is in the 17 September 2002 issue of Annals of Internal Medicine (volume 137, pages 479-486). The authors are KS Kinchen, J Sadler, N Fink, R Brookmeyer, MJ Klag, AS Levey, and NR Powe.

Ann Intern Med. 2002;137(6):I-24. doi:10.7326/0003-4819-137-6-200209170-00001
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What is the problem and what is known about it so far?

The kidneys filter out wastes and water from the blood. Chronic kidney disease causes kidney function to slowly worsen over time until the patient needs dialysis to survive. Dialysis filters the blood through artificial means. The care of patients with chronic kidney disease involves managing diet, blood pressure, and medications to delay the need for dialysis as long as possible, and then making an organized transition to dialysis. Some evidence suggests that the earlier patients with kidney disease receive care from a nephrologist (a doctor who specializes in kidney disease), the better they do. Unfortunately, patients often do not see a nephrologist until kidney disease is in its late stages.

Why did the researchers do this particular study?

1] To learn about factors associated with kidney disease patients' seeing nephrologists late in the course of their disease and 2) to see whether late evaluation by a nephrologist worsens survival.

Who was studied?

828 patients with chronic kidney disease who were starting dialysis.

How was the study done?

The researchers collected information about patients' personal characteristics, medical conditions, and laboratory tests. They also calculated the time between the first visit to a nephrologist and the beginning of dialysis. They defined late evaluation as first seeing a nephrologist less than 4 months before the start of dialysis, and early evaluation as first seeing a nephrologist more than 1 year before the start of dialysis. The researchers also monitored patients for 2 years to see whether they survived.

What did the researchers find?

Late evaluation by a nephrologist was most common in black men, in patients with no health insurance, and in patients with other medical conditions in addition to kidney disease. Patients who saw nephrologists late were more likely to die in the first 2 years after starting dialysis than patients who saw nephrologists early.

What were the limitations of the study?

This study does not provide detailed information about why patients saw nephrologists late in the course of their disease, but it suggests that insurance plays a role.

What are the implications of the study?

Patients with chronic kidney disease should talk to their doctors about seeing a nephrologist before their disease progresses to the point at which they need dialysis.





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