Korean Journal of Nephrology 2009;28(4):286-294.
The Impact of Timing of Nephrology Referral on Prognosis in Patients with Diabetic Chronic Kidney Disease
Dong-Young Lee, M.D., So Young Choi, M.D., Sung Yeon Cho, M.D., Ji Young Park, M.D., Sang-Ho Lee, M.D., Chun-Gyoo Ihm, M.D. and Tae-Won Lee, M.D.
Division of Nephrology, Department of Internal Medicine, School of Medicine, Kyung Hee University
임상연구 : 당뇨병성 만성 신장병 환자에서 신장내과 전과 시기가 예후에 미치는 영향
이동영, 최소영, 조성연, 박지영, 이상호, 임천규, 이태원
경희대학교 의학전문대학원 신장내과
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.
Key Words: Diabetic nephropathy, Referral, Dialysis


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