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Kidney Disease Patients Referred Late for Transplant

Earlier detection would reduce morbidity, mortality and progression to kidney failure

MONDAY, Nov. 20 (HealthDay News) -- Chronic kidney disease is becoming more prevalent and up to 64 percent of cases are referred late for renal replacement therapy, according to a review published in the November issue of the Mayo Clinic Proceedings.

Pieter Evenepoel, M.D., Ph.D., of the University Hospital Gasthuisberg in Leuven, Belgium, and colleagues examine the definition and epidemiology of late referral, defined in nephrology as progression to renal replacement therapy within one to six months of the initial consultation. They note that prevalence in the U.S. population is 11 percent and rising due to increased life expectancy and incidence of diabetic nephropathy.

The review reiterates National Kidney Foundation recommendations that all patients with stage 3 chronic kidney disease (i.e., a glomerular filtration rate of less than 60 mL/min per 1.73 m2), and all patients with proteinuria should be referred to a nephrologist when general practitioner care cannot properly evaluate or treat a patient.

"To optimize clinical care for patients with chronic kidney disease, more attention has to be paid to the integration of different specialties in patient care and the promotion of the collaboration between first-line general practitioners and nephrologists," the authors conclude. "Furthermore, multidisciplinary chronic kidney disease clinics should be installed. There is an urgent need for the further development and implementation of guidelines concerning referral."

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