Diegoli Henrique, Silva Marcelo Castro Gonçalves, Machado Diogo Spengler Barcelos, Cruz Carlos Eduardo Rilling da Nova
Universidade do Vale do Itajaí, Brasil.
J Bras Nefrol. 2015 Jan-Mar;37(1):32-7. doi: 10.5935/0101-2800.20150006.
Chronic kidney disease is defined by the progressive loss of renal function. Interventions in early stages significantly improve the prognosis of patients with chronic kidney disease, reducing the mortality, and many studies show that early nephrologist referral reduces the mortality rate.
To analyze the characteristics of the patients in dialysis and the time between the first consultation in the dialysis clinic and the beginning of the dialytic program.
It was made a cohort retrospective study with two analysis axis: the social and epidemiological characteristics of the patients in hemodialysis and the time between the first consultation in the clinic and the beginning of the dialytic program. Analytical and descriptive methods where used to compare these data with the early referral and the mortality 12 months after the dialysis onset.
One hundred and one patients were analyzed. The mortality rate of the early and lately referred patients was 47.8% and 20.5%, respectively (HR = 2.38; IC = 1.06-5.36; p = 0.035). Concerning the patients which initiated the dialysis with catheter and arteriovenous fistula, the mortality was respectively 51.4% and 10.3% (HR = 4.61; IC = 1,54-13,75; p = 0.006).
The referral timing was predominantly late. The late referral was associated with a greater mortality. Other variables associated with a greater mortality were age of 70 or more, presence of diabetes and the use of catheter by the dialysis onset.
慢性肾脏病是由肾功能进行性丧失所定义的。早期干预可显著改善慢性肾脏病患者的预后，降低死亡率，并且许多研究表明早期转诊至肾病科可降低死亡率。
分析透析患者的特征以及首次在透析门诊就诊至开始透析治疗之间的时间。
进行了一项队列回顾性研究，有两个分析轴：血液透析患者的社会和流行病学特征以及首次在门诊就诊至开始透析治疗之间的时间。采用分析和描述性方法将这些数据与早期转诊情况以及透析开始后12个月的死亡率进行比较。
分析了101例患者。早期转诊和晚期转诊患者的死亡率分别为47.8%和20.5%（风险比=2.38；可信区间=1.06 - 5.36；p=0.035）。对于采用导管和动静脉内瘘开始透析的患者，死亡率分别为51.4%和10.3%（风险比=4.61；可信区间=1.54 - 13.75；p=0.006）。
转诊时间主要较晚。晚期转诊与更高的死亡率相关。与更高死亡率相关的其他变量包括70岁及以上的年龄、糖尿病的存在以及透析开始时使用导管。
