The changing pattern of referral in XXXX .

@entity1 @entity177 @entity810 @entity1011 @entity454
BACKGROUND: @entity810 ( @entity810 ) is not only managed by nephrologists, but also by several other subspecialists. The referral rate to nephrologists and the factors influencing it are unknown. AIMS: To determine the referral rate, factors affecting referral and outcomes across the spectrum of @entity810 in a population based study. METHODS: We identified all patients with serum @entity1011 concentrations >= 150   mol/l (male) or >= 130   mol/l (female) over a 6-month period. @entity810 was defined according to the RIFLE classification (risk, @entity177 , loss, @entity454 [ @entity454 ]). Clinical information and outcomes were obtained from each @entity1 's case records. RESULTS: A total of 562 @entity1 were identified as having @entity810 (incidence 2147 per million population/year [pmp/y]). One hundred and sixty-four @entity1 (29%) were referred to nephrologists-referral rate 627 pmp/y. Forty-nine percent of patients whose serum @entity1011 rose to >300   mol/l were referred compared with 22% in our previous study of 1997. Forty-eight @entity1 required renal replacement therapy-incidence 184 pmp/y in comparison to 50 pmp/y in our previous study of 1997. @entity1 had higher odds of referral if they were male, of younger age and were in the F category of the RIFLE classification. @entity1 had lower odds of referral if they had multiple co-morbid conditions or if they were managed in a hospital without a nephrology service. CONCLUSION: There has been a significant rise in the referral rate of @entity1 with @entity810 to nephrologists but even during our period of study only one-third of such @entity1 were being referred. With rising incidence and increased awareness, the referral rate will certainly rise putting a significant burden on the nephrology services.
