Specialist follow up of patients before end stage renal failure and its relationship to survival on dialysis
J Stoves, C N Bartlett, C G Newstead
Department of
Renal Medicine, St James's University Hospital, Beckett Street, Leeds
LS9 7TF, UK
Correspondence to: Dr Stoves johnstoves{at}compuserve.com
Submitted 16 March
2001;
Accepted 25 April 2001
The high mortality rate of patients with end stage renal
failure (ESRF) treated 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 demonstrated that a short duration of
specialist predialysis follow up is associated with a worse long term
outcome on dialysis.
Kaplan-Meier survival curves were plotted according to duration of
predialysis follow up (group A, 
90 days; group B >90 days),
censoring for first transplant, and compared using a log rank test.
Differences between groups were examined using an
unpaired t test. Cox regression analysis was
performed to examine the influence of selected variables on survival.
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 respectively, p<0.001). The increased risk of death was
seen principally during the first few months of dialysis. ESRF
associated with systemic disease was more prevalent in A. There were
small but significant differences in predialysis clinical data,
including age and serum albumin (p<0.001). Fewer patients in A were
suitable for transplant listing (p<0.01). In the regression analysis,
age, diabetes, predialysis serum albumin, suitability for transplant
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
between late referral of ESRF patients and subsequent poor survival on
dialysis. This important message is relevant to all potential referring physicians.
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Key points
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Keywords: dialysis; survival; delayed referral; end stage renal failure
© 2001 by The Fellowship of Postgraduate Medicine
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