LATE REFERRALS TO KIDNEY REPLACEMENT THERAPY - NATIONAL-WIDE STUDY

 

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https://storage.unitedwebnetwork.com/files/1099/92755fcc0a8c2d207e9afefb0f742792.pdf
LATE REFERRALS TO KIDNEY REPLACEMENT THERAPY - NATIONAL-WIDE STUDY

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Ivan
Rychlik
Ivan Rychlik ivan.rychlik@fnkv.cz Charles University Hospital Dept. of Internal Medicine Prague Czech Republic *
Eva Nevrtalova eva.nevrtalova@uzis.cz Institute of Health Information and Statistics National Screening Centre Brno Czech Republic -
Pavel Nemec pavel.nemec@uzis.cz Institute of Health Information and Statistics National Screening Centre Brno Czech Republic -
Karel Hejduk karel.hejduk@uzis.cz Institute of Health Information and Statistics National Screening Centre Brno Czech Republic -
 
 
 
 
 
 
 
 
 
 
 

Late referral (LR) to KRT represents a significant problem as it is associated with higher morbidity/mortality, increased emergency dialysis starts, lower likelihood of vascular access creation, reduced chances of pre-emptive transplantation and higher healthcare costs. LR is commonly defined based on the timing of nephrology consultation prior to the initiation of dialysis (or other forms of KRT), usually as >90 days before first dialysis procedure. Despite LR is problem lasting for many years in all industrialized countries, exact numbers based on national wide data are not available.

Data from the National Register of Health Services (NRHZS) covering all health care procedures in all county population (10,5 millions) were used to identify patients (pts) entering chronic dialysis therapy in 2019–2023, based on reporting hemodialysis/hemodiafiltration or peritoneal chronic dialysis treatments >90 days. Then each single pts was analysed to see whether, when and how many times he had been examined by a nephrologist before starting the first reported procedure. Further we identified pts who had at least 1 visit to a nephrologist 90-365 or >365 days before starting dialysis. 

In years 2019-2023, altogether 12952 pts started dialysis therapy, 8011 out of them fulfilled definition of chronic dialysis pts, most of them (6845=85%) being >50yrs old. Each year in average 75,9% (72,3-78,5) were seen by nephrologist >90 days before first dialysis, however 9,7% (6,9-11,4) of them had last visit >365 days before first dialysis. Thus 31,5% (28,2-36,0) were late referrals.

This is the first study covering all country population and analysing the precise data based on individual data using national ID number. We proved that in average 31,5% of all pts entering chronic dialysis therapy are referred late to nephrologist, thus not sufficiently prepared for KRT. Despite modern ways of CKD screening and wide availability of CKD treatments, this number still remains high and alarming.

Kewords