How does late nephrological co-management impact chronic kidney disease? – An observational study

摘要: Summary Aims:  To assess the impact of late referral (LR) for nephrological co-management compared with early (ER) on morbidity and mortality in chronic kidney disease (CKD) to identify individual factors associated higher LR, correcting lead-time immortal time bias. Patients methods:  Retrospective observational study comparing 46 LR patients 103 ER patients. The quality CKD management was assessed by measures prevent progression modify complications cardiovascular risk according current guidelines. One-year were identified. Analysis performed equivalent GFR (glomerular filtration rate) at baseline correct bias. Results:  Late inferior control most progression, factors. In particular, glycaemic control, use angiotensin converting enzyme inhibitors angiotensin-2-receptor blockers diabetic nephropathy or proteinuria, nutritional volume status LR. significantly (RR 5.9 (95% CI 1.5–19.6); p < 0.01). Inadequate blood pressure, anaemia, status, malnutrition emergency initial dialysis, but not itself independently mortality. Conclusions:  a substantially lower survival after correction bias may particularly profit from adequate avoidance dialysis as these predominately contribute survival.