Late presentation of XXXX with end-stage renal disease for renal replacement therapy--is it always avoidable?

@entity1 @entity8 @entity740 @entity177 @entity810
BACKGROUND: Twenty-five to 30% of new renal replacement therapy (RRT) @entity1 present late to renal services. The proportion in whom this is avoidable, and whether awareness of @entity740 ( @entity740 ) has reduced its incidence is not known. METHODS: Adult @entity1 starting RRT (2003-2008) in a single unit were grouped according to the time interval between first presentation to the unit and start of RRT: <90 days (late presenters); 90-364 days; >=  365 days. 'Late presenters' were classified as follows: @entity810 -- @entity1 who had acute but irreversible @entity177 ; 'avoidable' late referrals, if they had known pre-existing @entity740 and 'unavoidable' late referrals, if they had unpredictable rapid progression of their @entity740 or had no prior contact with health care. Mortality risk associated with late presentation was explored using multivariable Cox regression. RESULTS: Late presentation was common (24.3%) but late referrals accounted for only 7.4% and 3.9% were avoidable. The incidence of late referrals decreased from 9.2% in 2003-2005 to 5.5% in 2006-2008 (trend P = 0.07). Late presentation was associated with increased mortality after adjusting for comorbidity, transplantation and permanent vascular access, and the majority of late presenters died due to @entity8 . CONCLUSIONS: The lower incidence of late referrals and the falling trend could be due to implementation of automated estimated glomerular filtration rate reporting and the increased awareness of @entity740 in primary care. Future prospective studies are needed to examine the extent to which frailty contributes to this mortality risk.
