Specialist follow up of patients before end stage renal failure and its relationship to survival on dialysis

The high mortality rate of patients with end stage renal failure (ESRF) tre ated by dialysis is determined principally by irreversible factors such as age and comorbidity. In this single centre retrospective study of all 1260 ESRF patients who started dialysis between 1980 and 1999 it has been demons trated that a short duration of specialist predialysis follow up is associa ted with a worse long term outcome on dialysis. Kaplan-Meier survival curves were plotted according to duration of predialy sis follow up (group A, less than or equal to 90 days; group B >90 days), c ensoring for first transplant, and compared using a log rank test. Differen ces between groups were examined using an unpaired t test. Cox regression a nalysis was performed to examine the influence of selected variables on sur vival. Group A had the worst mortality (survival proportions of 87%, 74%, and 31% in A and 94%, 87%, and 55% in B at four months, one year, and five years re spectively, p<0.001). The increased risk of death was seen principally duri ng the first few months of dialysis. ESRF associated with systemic disease was more prevalent in A. There were small but significant differences in pr edialysis clinical data, including age and serum albumin (p<0.001). Fewer p atients in A were suitable for transplant listing (p<0.01). In the regressi on analysis, age, diabetes, predialysis serum albumin, suitability for tran splant work-up and listing ("transplantability"), and the interval between referral and dialysis were significant predictors of survival. In summary, this study strengthens the previously reported association betw een late referral of ESRF patients and subsequent poor survival on dialysis . This important message is relevant to all potential referring physicians.