Longer duration of predialysis nephrological care is associated with improved long‐term survival of dialysis patients

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Abstract
Background. Late nephrological referral of chronic renal failure patients has been shown to be associated with high morbidity and short‐term mortality on dialysis. However, the impact of predialysis nephrological care duration (PNCD) on the long‐term survival of dialysis patients had not been evaluated. Methods. We studied data from all 1057 consecutive patients who started dialysis treatment at the Necker Hospital from 1989 to 1998 (mean age at start of dialysis 53.8±17.2 years (range 18–91 years), excluding from analysis patients who presented with acute renal failure (n=60) or advanced malignancy (n=35). We evaluated the effects of PNCD and clinical risk factors on all‐cause mortality after long‐term follow‐up on dialysis. Results. Among the 1057 patients analysed (13.2% diabetics), PNCD was PPConclusions. This study provides suggestive evidence that longer duration of regular nephrological care in the predialysis period, at least for several years prior to the start of dialysis, is associated with a better long‐term survival on dialysis. Such data strongly support the argument for early referral and regular nephrological care of chronic renal failure patients.