LA DERIVACION TEMPRANA AL NEFROLOGO MEJORA LOS RESULTADOS A LARGO PLAZO EN LA ENFERMEDAD RENAL CRONICA





LA DERIVACION TEMPRANA AL NEFROLOGO MEJORA LOS RESULTADOS A LARGO PLAZO EN LA ENFERMEDAD RENAL CRONICA

(especial para SIIC © Derechos reservados)
La derivación temprana de los pacientes con enfermedad renal crónica al nefrólogo es necesaria para mejorar los resultados a largo plazo en cuanto a morbilidad y mortalidad.
penaporta9.jpg Autor:
José María Peña Porta
Columnista Experto de SIIC

Institución:
Hospital de Barbastro


Artículos publicados por José María Peña Porta
Coautor
Carmen Vicente de Vera Floristán* 
Doctora en Medicina y Cirugía, Hospital Universitario Arnau de Vilanova, Lérida, España*
Recepción del artículo
4 de Febrero, 2008
Aprobación
5 de Junio, 2008
Primera edición
27 de Octubre, 2008
Segunda edición, ampliada y corregida
7 de Junio, 2021

Resumen
La enfermedad renal crónica es una patología creciente en todo el mundo y cada vez es mayor la prevalencia de pacientes en diálisis, lo que ocasiona un costo muy elevado. En los últimos años han cobrado relevancia los adecuados cuidados en la etapa prediálisis. Para ello es fundamental detectar la enfermedad en sus primeras fases, lo que puede permitir adoptar las medidas necesarias para su tratamiento o, en su caso, retrasar su progresión y prevenir las complicaciones asociadas. A pesar de todo siguen siendo muchos los pacientes que son vistos por primera vez por un especialista en nefrología en etapas avanzadas de la enfermedad como consecuencia de su derivación tardía. Los factores que ocasionan este fenómeno son numerosos e implican tanto a los médicos, como a los pacientes y al sistema sanitario. Las consecuencias negativas de la derivación tardía ya han sido demostradas en cuanto a morbilidad, mortalidad y costos, pero todavía no está demostrado cuál es el mejor momento de iniciar la diálisis en función del filtrado glomerular. Es imprescindible la elaboración y difusión de guías clínicas junto con la colaboración entre nefrólogos y médicos generales para disminuir el impacto de la derivación tardía.

Palabras clave
referencia tardía, inicio de diálisis, enfermedad renal crónica


Artículo completo

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Abstract
Chronic kidney disease is increasing worldwide, and its prevalence in patients on hemodialysis keeps growing, causing a steep rise in health care expenditures. In recent years, the importance of appropriate patient care at the pre-dialysis stage, has gained relevance. Therefore, detection of the disease in its early stages is essential, since it would allow for treatment measures to slow its progression and prevent associated complications. In spite of those efforts, a great number of patients consult the nephrologist in advanced stages of renal disease, due to late referrals. This situation, which involves physicians, patients, and the healthcare system, is caused by multiple factors. The negative consequences of late referrals on morbility, mortality and healthcare expenditures were demonstrated, but the best time to start dialysis based on the glomerular filtration rate, has not been determined yet. In order to diminish the impact of late referrals, the development and dissemination of clinical guidelines together with a coordinated action between nephrologists and general practitioners are essential.

Key words
late referral, start of dialysis, chronic kidney disease


Clasificación en siicsalud
Artículos originales > Expertos de Iberoamérica >
página   www.siicsalud.com/des/expertocompleto.php/

Especialidades
Principal: Nefrología y Medio Interno
Relacionadas: Administración Hospitalaria, Atención Primaria, Bioquímica, Diagnóstico por Laboratorio, Educación Médica, Emergentología, Epidemiología, Farmacología, Geriatría, Medicina Interna, Salud Pública



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José María Peña Porta, Hospital de Barbastro, 25199, C/ Vall Fosca 11, Huesca, España
Bibliografía del artículo
1. Coresh J, Astor BC, Greene T, Eknoyan G, Levey AS. Prevalence of chronic kidney disease and decreased kidney function in the adult US population: Third National Health and Nutrition Examination Survey. Am J Kidney Dis 41:1-12, 2003.
2. http://nefrologia.grupoaulamedica.com/ficha2.asp?id=74 (consultado el 31/1/2007 a las 17 horas).
3. Grassmann A, Gioberge S, Moeller S, Brown G. ESRD patients in 2004: global overview of patient numbers, treatment modalities and associated trends. Nephrol Dial Transplant 20:2587-93, 2005.
4. St Peter, Schoolwerth AC, McGowan, McClellan. Chronic kidney disease: issues and establishing programs and clinics for improved patient outcomes. Am J Kidney Dis 41:903-924, 2003.
5. Obrador GT, Pereira BJ. Early referral to the nephrologist and timely initiation of renal replacement therapy: A paradigm shift in the management of patients with chronic renal failure. Am J Kidney Dis 31:398-417, 1998.
6. Huisman RM. The deadly risk of late referral. Nephrol Dial Transplant 19:2175-80, 2004.
7. Sprangers B, Evenepoel P, Vanrenterghem Y. Late referral of patients with chronic kidney disease: no time to waste. Mayo Clin Proc 81:1487-94, 2006.
8. Levin A. Consequences of late referral on patient outcomes. Nephrol Dial Transplant 15(Supl.3):S8-S13, 2000.
9. Wauters JP, Lameire N, Davison A, Ritz E.Why patients with progressing kidney disease are referred late to the nephrologist: on causes and proposals for improvement. Nephrol Dial Transplant 20:490-6, 2005.
10. Ismail N, Neyra R, Hakim R. The medical and economical advantages of early referral of chronic renal failure patients to renal specialists. Nephrol Dial Transplant 13:246-50, 1998.
11. Khan IH, Catto GR, Edward N, MacLeod AM. Chronic renal failure: factors influencing nephrology referral. QJM 87:559-564, 1994.
12. Mendelsshon DC, Singer PA. Referral for dialysis in Ontario. Arch Intern Med 155:2473-2478, 1995.
13. Eadington DW. Delayed referral for dialysis. Nephrol Dial Transplant 11:2124-2126, 1996.
14. Arora P, Obrador GT, Ruthazer R, Kausz AT, Meyer KB, Jenuleson CS, Pereira BJG. Prevalence, predictors, and consequences of late nephrology referral at a tertiary care center. J Am Soc Nephrol 10:1281-1286, 1999.
15. Astor BC, Eustace JA, Powe NR, Klag MJ, Sadler JH, Fink NE, Coresh J. Timing of nephrologist referral and arteriovenous access use: the CHOICE study. Am J Kidney Dis 38:494-501, 2001.
16. Avorn J, Winkelmayer WC, Bohn RL, et al. Delayed nephrologist referral and inadequate vascular access in patients with advanced chronic kidney failure. J Clin Epidemiol 55:711-716, 2002.
17. Cass A, Cunningham J, Arnold PC, Snelling P, Wang Z, Hoy W. Delayed referral to a nephrologist: outcomes among patients who survive at least one year on dialysis. Med J Aust 177:135-138, 2002.
18. Ellis PA, Reddy V, Bari N, Cairns HS. Late referral of end-stage renal failure. QMJ 91:727-732, 1998.
19. Ifudu O, Dawood M, Homel P, Friedman EA: Excess morbidity in patients starting uremia therapy without prior care by a nephrologist. Am J Kidney Dis 28:841-845, 1996.
20. Jungers P, Joly D, Nguyen-Khoa T, Mothu N, Bassilios N, Grünfeld JP. Continued late referral of patients with chronic kidney disease. Causes, consequences, and approaches to improvement Presse Med 35:17-22, 2006.
21. Jungers P, Massy ZA, Nguyen-Khoa T, Choukroun G, Robino C, Fakhouri F, Touam M, Nguyen AT, Grünfeld JP. Longer duration of predialysis nephrological care is associated with improved long-term survival of dialysis patients. Nephrol Dial Transplant 16:2357-2364, 2001.
22. Kinchen KS, Sadler J, Fink N, Brookmeyer R, Klag MJ, Levey AS, Powe NR. The timing of specialist evaluation in chronic kidney disease and mortality. Ann Inter Med 137:479-486, 2002.
23. Lameire N, Van Viesen W. The pattern of referral of patients with end-stage renal disease to the nephrologist-a european survey. Nephrol Dial Transplant 14(Supl.6):16-23, 1999.
24. Roubicek C, Brunet P, Huiart L, Thirion X, Leonetti F, Dussol B, Jaber K, Andrieu D, Ramananarivo P, Berland Y. Timing of nephrology referral: influence on mortality and morbidity. Am J Kidney Dis 36:35-41, 2000.
25. Sesso R, Belasco AG. Late diagnosis of chronic renal failure and mortality in maintenance dialysis. Nephrol Dial Transplant 11:2417-2420, 1996.
26. Schmidt RJ, Domico JR, Sorkin MI, Hobbs G. Early referral and its impact on emergent first dialyses, health care cost, and outcome. Am J Kidney Dis 32:278-283, 1998.
27. Stack AG. Impact of timing of nephrology referral and pre-ESRD care on mortality risk among new ESRD patients in the united states. Am J Kidney Dis 41:310-318, 2003.
28. Winkelmayer WC, Owen W, Levin R, Avorn J. A propensity analysis of late versus early nephrologist referral and mortality on dialysis. J Am Soc Nephrol 14:486-492, 2003.
29. Roderick P, Jones C, Tomson C, Mason J. Late referral for dialysis: improving the management of chronic renal disease. QJMed 95:363-370, 2002.
30. Gallego E, López A, Lorenzo I, López E, Llamas F, Illescas ML, Andrés E, Serrano A, Olivas E, Gómez Roldán C. Referencia precoz y tardía al nefrólogo, su influencia en la morbi-mortalidad en hemodiálisis. Nefrología 23:234-242, 2003.
31. Obialo CI, Ofili EO, Quarshie A, Martin PC. Ultralate referral and presentation for renal replacement therapy: socioeconomic implications. Am J Kidney Dis 46:881-6, 2005.
32. Navaneethan SD, Nigwekar S, Sengodan M, Anand E, Kadam S, Jeevanantham V, Grieff M, Choudhry W. Referral to nephrologists for chronic kidney disease care: is non-diabetic kidney disease ignored? Nephron Clin Pract 106:113-8, 2007.
33. Nakamura S, Nakata H, Yoshihara F, Kamide K, Horio T, Nakahama H, Kawano Y. Effect of early nephrology referral on the initiation of hemodialysis and survival in patients with chronic kidney disease and cardiovascular diseases. Circ J 71:511-6, 2007.
34. Schwenger V, Morath C, Hofmann A, Hoffmann O, Zeier M, Ritz E. Late referral- a major cause of poor outcome in the very elderly dialysis patient. Nephrol Dial Transplant 21:962-7, 2006.
35. Bradbury BD, Fissell RB, Albert JM, Anthony MS, Critchlow CW, Pisoni RL, Port FK,Gillespie BW. Predictors of early mortality among incident US hemodialysis patients in the Dialysis Outcomes and Practice Patterns Study (DOPPS). Clin J Am Soc Nephrol 2:89-99, 2007.
36. Metcalfe W, Khan IH, Prescott GJ, Simpson K, MacLeod AM. Can we improve early mortality in patients receiving renal replacement therapy? Kidney Int 57:2539-45, 2000.
37. Kessler M, Frimat L, Panescu V, Briançon S. Impact of nephrology referral on early and midterm outcomes in ESRD: EPidémiologie de l'Insuffisance Renale chronique terminale en Lorraine (EPIREL): results of a 2-year, prospective, community-based study. Am J Kidney Dis 42:474-85, 2003.
38. Stoves J, Bartlett CN, Newstead CG. Specialist follow up of patients before end stage renal failure and its relationship to survival on dialysis. Postgrad Med J 77:586-8, 2001.
39. Peña JM, Logroño JM, Pernaute R, Laviades C, Virto R, Vicente de Vera C. Late nephrology referral influences on morbidity and mortality of hemodialysis patients. A provincial study. Nefrologia 26:84-97, 2006.
40. Levey AS, Coresh J, Balk E, Kausz AT, Levin A, Steffes MW, Hogg RJ, Perrone RD,Lau J, Eknoyan G. National Kidney Foundation. National Kidney Foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Ann Intern Med 139:137-47, 2003.
41. Stevens LA, Coresh J, Greene T, Levey AS. Assessing Kidney function- measured and estimated glomerular filtration rate. N Engl J Med 354:2473-83, 2006.
42. Stevens LA, Levey AS. Chronic Kidney disease in the elderly - How to assess risk? N Engl J Med 352:2122-24, 2005.
43. Cockcroft DW, Gault MG. Prediction of creatinine clearance from serum cretinine. Nephron 16:31-41, 1976.
44. Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum cretinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med 130:461-70, 1999.
45. Levey AS, Greene T, Kusec JW, Beck GJ, Group MS. A simplified equation to predict glomerular filtration rate from serum cretinine. J Am Soc Nephrol 11:A0828, 2000.
46. Peña JM. Utilidad y relevancia clínica de la determinación del filtrado glomerular calculado. Rev Clin Esp 207:249-252, 2007.
47. Fernández-Fresnedo G, De Francisco ALM, Rodrigo E, Piñera C, Herráez I, Ruiz C y Arias M. Insuficiencia renal "oculta" por valoración de la función renal mediante creatinina sérica. Nefrología 22:144-51, 2002.
48. Peña JM, Vicente de Vera C, Bueno M. Insuficiencia renal oculta y prescripción de fármacos en pacientes hospitalizados. An Med Interna (Madrid) 24:221-226, 2007.
49. Duncan L, Heathcote J, Djurdjev O, Levin A. Screening for renal disease using serum creatinine: who are we missing? Nephrol Dial Transplant 16:1042-46, 2001.
50. Gracia S, Montañes R, Bover J, Cases A, Deulofeu R, De Francisco ALM, et al. Recomendaciones sobre la utilización de ecuaciones para la estimación del filtrado glomerular en adultos. Nefrología 26:658-65, 2006.
51. Keith DS, Nichols GA, Gullion CM, Brown JB, Smith DH. Longitudinal follow-up and outcomes among a population with chronic kidney disease in a large managed care organization. Arch Int Med 164:659-663, 2004.
52. Wauters JP, Lameire N, Davison A, Ritz E. Why patients with progressing kidney disease are referred late to the nephrologist: on causes and proposals for improvement. Nephrol Dial Transplant 20:490-6, 2005.
53. Pollock CA, Cooper BA, Harris DC. Early start peritoneal dialysis. Adv Chronic Kidney Dis 14:27-34, 2007.
54. Wilson B, Harwood L, Locking-Cusolito H, Chen SJ, Heidenheim P, Craik D, Clark WF.Optimal timing of initiation of chronic hemodialysis? Hemodial Int 11:263-9, 2007.
55. Khan SS, Xue JL, Kazmi WH, Gilbertson DT, Obrador GT, Pereira BJ, Collins AJ. Does predialysis nephrology care influence patient survival after initiation of dialysis? Kidney Int 67:1038-46, 2005.
56. Kazmi WH, Obrador GT, Khan SS, Pereira BJ, Kausz AT. Late nephrology referral and mortality among patients with end-stage renal disease: a propensity score analysis. Nephrol Dial Transplant 19:1808-14, 2004.
57. McLaughlin K, Manns B, Culleton B, Donaldson C, Taub K. An economic evaluation of early versus late referral of patients with progressive renal insufficiency. Am J Kidney Dis 38:1122-1128, 2001.
58. Caskey FJ, Wordsworth S, Ben T, De Charro FT, Delcroix C, Dobronravov V, Van Hamersvelt H, Henderson I, Kokolina E, Khan IH, Ludbrook A, Luman M, Prescott GJ, Tsakiris D, Barbullushi M, MacLeod AM; EURODICE group. Early referral and planned initiation of dialysis: what impact on quality of life? Nephrol Dial Transplant 18:1330-8, 2003.
59. Oliver MJ, Rothwell DM, Fung K, Hux JE, Lok CE. Late creation of vascular access for hemodialysis and increased risk of sepsis. J Am Soc Nephrol 15:1936-42, 2004.
60. Rasgon S, Schwankovsky L, James-Rogers A, Widrow L, Glick J, Butts E. An intervention for employement maintenance among blue-collar workers with end-stage renal disease. Am J Kidney Dis 22:403-412, 1993.
61. Binik YM, Dervis GM, Barre PE, Grittman RD, Mandini H, Paul LC et al. Live and learn: patient education delays the need to initiate renal replacement therapy in ESR diseases. J Nerv Mental Dis 181:371-376, 1993.
62. Traynor JP, Simpson K, Geddes CC, Deighan CJ, Fox JG. Early initiation of dialysis fails to prolong survival in patients with end-stage renal failure. J Am Soc Nephrol 13:2125-2132, 2002.
63. Bonomini V, Feletti C, Scolari MP, Stefoni S. Benefits of early initiation of dialysis. Kidney Int 28:S57-S59, 1985.
64. Beddhu S, Samore MH, Roberts MS, Stoddard GJ, Ramkumar N, Pappas LM, Cheung AK. Impact of timing of initiation of dialysis on mortality. J Am Soc Nephrol 14:2305-12, 2003.
65. Cooper BA, Branley P, Bulfone L, Collins JF, Craig JC, Dempster J, Fraenkel MB, Harris A, Harris DC, Johnson DW, Kesselhut J, Luxton G, Pilmore A, Pollock CA, Tiller DJ; IDEAL Study Steering Committee. The Initiating Dialysis Early and Late (IDEAL) study: study rationale and design. Perit Dial Int 24:176-81, 2004.
66. Stevens LA, Fares G, Fleming J, Martin D, Murthy K, Qiu J, Stark PC, Uhlig K, Van Lente F, Levey AS. Low rates of testing and diagnostic codes usage in a commercial clinical laboratory: evidence for lack of physician awareness of chronic kidney disease. J Am Soc Nephrol 16:2439-48, 2005.
67. Lea JP, McClellan WM, Melcher C, Gladstone E, Hostetter T. CKD risk factors reported by primary care physicians: do guidelines make a difference? Am J Kidney Dis 47:72-7, 2006.
68. Bang H, Vupputuri S, Shoham DA, Klemmer PJ, Falk RJ, Mazumdar M, Gipson D,Colindres RE, Kshirsagar AV. Screening for Occult Renal Disease (SCORED): a simple prediction model for chronic kidney disease. Arch Intern Med 167:374-81, 2007.
69. Levin A, Lewis M, Mortiboy P, Faber S, Hare I, Porter EC, Mendelssohn DC. Multidisciplinary predialysis programs: quantification and limitations of theirimpact on patient outcomes in two Canadian settings. Am J Kidney Dis 29:533-40, 1997.
70. Owen JE, Walker RJ, Edgell L, Collie J, Douglas L, Hewitson TD, Becker GJ. Implementation of a pre-dialysis clinical pathway for patients with chronic kidney disease. Int J Qual Health Care 18:145-51, 2006.
71. Mendelssohn DC. Coping with the CKD epidemic: the promise of multidisciplinary team-based care. Nephrol Dial Transplant 20:10-2, 2005.
72. Blasco M, Peña JM, Vicente de Vera C, Lorente T. Valoración de la función renal desde atención primaria. Aten Primaria 39:570-571, 2007.
73. www.senefro.org/modules/subsection/files/consenso_erc.pdf?check_idfile=2996 (consultado el 31/1/2007 a las 17 horas).

 
 
 
 
 
 
 
 
 
 
 
 
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