Epidemiological factors associated with early referral to a nephrologist to start chronic hemodialysis in patients at a public hospital in Peru

© 2018, Asociacion Regional de Dialisi y Transplantes Renales. All rights reserved. Objective: The aim of this study was to establish the prevalence of early referral to a nephrologist to start hemodialysis and the associated epidemiological factors in patients suffering from chronic kidney disease treated at a public hospital in Peru. Material and methods: A retrospective, analytical, observational study with a cross-sectional design was conducted in patients starting HD at a public hospital in Peru. The main variable was early referral, defined as that which happens when patients are instructed to start HD 180 days after they were treated at the nephrology department for the first time. Epidemiological and lab variables were collected. Raw and adjusted generalized linear models (GLM) were employed; prevalence ratio (PR) was calculated with 95% CI as measure of association. Results: The study included 148 patients; early referral was observed in 17% of cases. According to adjusted GLM, patients older than 60 showed a higher prevalence of early referral to a nephrologist: PR=2.17; 95% CI (1.09- 4.32); p=0.03. A lower prevalence of early referral was observed among patients with severe anemia and hypercreatinemia: PR=0.15; 95% CI (0.02- 1.11); p=0.06 and PR=0.19; 95% CI (0.10 -0.36); p<0.01, respectively. Conclusions: The percentage of early referral is low and this should be considered as a public health issue. Improvements in referral systems and health care in all levels are recommended.