Hippokratia 2005; 9 (1):45-48
O. Stojceva - Taneva, N Ivanovski, G Selim, K Zafirovska, R Grozdanovski
Nephrology Dpt, Clinical Center, University "St. Cyril and Methodius", Skopje, F.Y.R.M.
Background. Starting in 1999, the Outpatient Clinic of the Department of Nephrology in Skopje has conducted a prospective survey on the incidence of end-stage renal failure (ESRF) patients requiring renal replacement therapy (RRT) in the whole country, including late, as well as early referrals that have been followed up by nephrologists.
Methods: A total of 168 ESRF patients have been accepted for RRT in 1999 in the F.Y.R.M, 156 in Skopje and 12 in Struga. Data have been obtained from the medical records of all the patients in Skopje, and complete laboratory data have been obtained from 136 patients in Skopje that have been statistically analyzed.
Results: Sixteen out of 168 patients died during their hospitalization during the first month after starting RRT, so 140 patients continued on maintenance hemodialysis in Skopje and 12 in Struga, a total of 152, or an incidence of 76 / milion population. The male / female ratio was 45.5 / 54.5%. The number of late referrals was incredibly high, 79.5% compared to early ones, 20.5%. The early referrals had a significantly higher endogenous creatinine clearance (Ccr) and calculated Ccr at start of RRT, 7.7±3.5 and 9,2±5.4 ml / min, respectively, compared to the late ones, 6.1±4.3 and 7.02±3.9 ml / min respectively, p< 0.05. The group of patients who died during hospitalization were significantly older than those who survived, 61.1±15.8 compared to 54.3± 14.2 years, and had lower albumin levels, 30.6±6.5 g / l compared to 34.7±6.4 g / l, p < 0.05. Of the 16 patients who died, 14 were from the late referrals, and only 2 from the early ones, p < 0.05. Patients with diabetic nephropathy started RRT with a significantly higher Ccr and calculated Ccr compared to other causes of ESRF, 8.4±3.3 and 11.7±6.5 ml / min respectively, compared to 5.7±4.2 and 6.3±2.6 ml / min respectively, p < 0.01 and p < 0.000000.
Conclusions: The number of late referrals of patients with ESRF, to nephrologists, for RRT in F.Y.R.M. is extremely high and the initiation of RRT is not optimal, affecting early morbidity and mortality of ESRF patients.
Keywords: early referrals, end stage renal failure, late referrals, mortality