SUN-234 CIRCUMSTANCES OF HEMODIALYSIS INITIATION: IMPACT OF LATE REFERRAL

Abstract

End-stage renal disease (ESRD) is a major public health worldwide with an incidence in constant progression according to different Dialysis Registries. Patients are often sent late to nephrologists, which is a source of complications recognized in several countries. For these reasons, we tried to evaluate, in our context, the effects of this late referral (LR) on patients’ outcomes. This is a prospective study which included all patients initiating hemodialysis (HD) between January and June 2017. Two groups were individualized according to the period of follow up before HD initiation. The first group, called ‘early referral’ (ER), gathers patients who were followed up during a minimum of 6 months before dialysis initiation. The second, ‘late referral’ (LR), consists on the group of patients who were followed up less than 6 months or never followed up before dialysis initiation. During the study period, 229 patients were admitted for HD. Their average at HD initiation was 60,2 ± 15,3 years old and diabetic nephropathy was the most common cause of 48,9% of cases. Only 132 patients (57,6%) were early referred to a nephrologist. Patients in the group LR were more likely to initiate HD in urgent way (70% VS 46,9%; p = 10-3) with a more frequent use of temporary central venous catheter (99% VS 82,6%; p = 10-3). The mean of hemoglobin rates was significantly higher in the ER group (8,6 ± 1,6 g/dl VS 7,9 ± 1,4 g/dl; p = 10-3). Otherwise, the mean of calcium, phosphorus, CRP, and albumin rates were comparable between the 2 groups. Patients requiring hospitalization in order to initiate HD were more frequent in LR group (60,8% VS 37,1%; p = 10-3). Even the length of hospital stay was longer in the LR group (30 VS 23 days; p = 0,06). Patients receiving vaccination against hepatitis B were more important in the group ER (58,5% VS 38,5%; p = 0,003). However, there was no difference between the 2 groups according to the mortality risk during the first 3 months and even the first year of dialysis. Early referral may be beneficial because it allows dialysis planification and treatment of the complications of progressive uremia. But, Early death on HD seems not to be associated with late referral to a nephrologist.