MD, PhD. Nephrology Project Manager, Municipal Health Department of Santana de Parnaíba, Santana de Parnaíba (SP), Brazil; National Nephrology Coordinator, Grupo NotreDame Intermédica, São Paulo (SP), Brazil; Former Nephrology Coordinator, Hospital Leforte, São Paulo (SP), Brazil; and Postdoctoral Researcher, Department of Medicine, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil.
MD. Doctoral Student, Department of Medicine, Division of Nephrology, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil.
Sao Paulo Med J. 2022 May-Jun;140(3):366-371. doi: 10.1590/1516-3180.2021.0194.R1.13082021.
The number of nephrologists has risen slowly, compared with the prevalence of chronic kidney disease (CKD) in Brazil. Data on patients referred to nephrology outpatient clinics remains scarce.
To determine the demographic and kidney function characteristics of patients at their first appointment with a nephrologist.
Retrospective study conducted at three nephrology outpatient clinics (public and private services), in São Paulo, Brazil.
From December 2019 to February 2020, we collected patient data regarding demographics, kidney function parameters and comorbidities. We then analyzed data on 394 patients who met a nephrologist for their first appointment.
The main comorbidities were hypertension (63.7%), diabetes (33.5%) and nephrolithiasis (22.3%). Regarding CKD stages, 24.1%, 9.1%, 13.7%, 15.2%, 15.2% and 2.3% of the patients were in stages 1, 2, 3a, 3b, 4 and 5, respectively. Proteinuria was absent or mild, moderate and high in 17.3%, 15.2% and 11.7%, respectively; and 16.2% had not undergone previous investigation of serum creatinine or proteinuria (55.8%). For 17.5%, referral to a nephrologist occurred late. Patients in public services were older than those in private services (59 years versus 51 years, respectively; P = 0.001), more frequently hypertensive (69.7% versus 57.5%; P = 0.01) and reached a nephrologist later (22.4% versus 12.4%; P = 0.009).
Referrals to a nephrologist were not being made using any guidelines for CKD risk and many cases could have been managed within primary care. Late referral to a nephrologist happened in one-fifth of the cases and more frequently in the public service.
与巴西慢性肾脏病（CKD）的流行程度相比，肾病学家的数量增长缓慢。关于肾病门诊就诊患者的数据仍然很少。
确定首次就诊于肾病医生的患者的人口统计学和肾功能特征。
这是一项在巴西圣保罗的三个肾病门诊（公共和私人服务）进行的回顾性研究。
2019 年 12 月至 2020 年 2 月，我们收集了患者的人口统计学、肾功能参数和合并症数据。然后，我们分析了 394 名首次就诊于肾病医生的患者的数据。
主要合并症为高血压（63.7%）、糖尿病（33.5%）和肾结石（22.3%）。根据 CKD 分期，分别有 24.1%、9.1%、13.7%、15.2%、15.2%和 2.3%的患者处于 1 期、2 期、3a 期、3b 期、4 期和 5 期。蛋白尿分别为无或轻度、中度和重度，分别占 17.3%、15.2%和 11.7%；16.2%的患者未进行过血清肌酐或蛋白尿的先前检查（55.8%）。17.5%的患者转诊至肾病医生的时间较晚。公共服务的患者比私人服务的患者年龄更大（分别为 59 岁和 51 岁，P=0.001），高血压更常见（分别为 69.7%和 57.5%，P=0.01），并且较晚转诊至肾病医生（分别为 22.4%和 12.4%，P=0.009）。
对肾病医生的转诊并未使用任何 CKD 风险指南，许多病例本可以在初级保健中得到管理。有五分之一的病例出现了对肾病医生的延迟转诊，而且这种情况在公共服务中更为常见。
