Detrimental Effects of Late Referral for Dialysis

The potential benefits of early referral to a nephrologist of chronic uremics include slowing the rate of decline associated with progressive renal insufficiency and facilitating efficient entry into dialysis programs. Late referral is associated with complications that are uncommon among early referrals. This study aim to evaluate the pattern of referral among chronic uremics with a view to identifying associated problems. All the patients seen with chronic renal failure during a five-year period in the dialysis unit of the hospital had their medical records reviewed. Information was extracted on the clinical data and laboratory records. Ninety patients were seen in the dialysis unit of the hospital during this period. The mean age was 38.3+ 1.6 years (range 10-69 years) with a peak incidence in the second decade. Most patients were referred late from the private medical clinics 34(37.8 % ) and the general hospitals 32(35.6 % ). Seventy (77.8 % ) patients were initially diagnosed as chronic uremics, six months prior to referral. The aim of referring in most cases was persistent uremic symptoms and necessity for dialysis. Only 14(15.6 %) patients presented without complications. The commonest were pulmonary edema, (28.9 % ) biventricular failure (22.2 % ) and hypertension (20 % ). The majority of the patients were referred late to nephrologists and presented with complications. Chronic Renal Failure patients should be referred early to nephrologists so as to prevent/reduce morbidity and mortality.