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Canadian survey of clinical status at dialysis initiation 1998-1999: a multicenter prospective survey.

https://arctichealth.org/en/permalink/ahliterature188002
Source
Clin Nephrol. 2002 Oct;58(4):282-8
Publication Type
Article
Date
Oct-2002
Author
B M Curtis
B J Barret
K. Jindal
O. Djurdjev
A. Levin
P. Barre
K. Bernstein
P. Blake
E. Carlisle
P. Cartier
C. Clase
B. Culleton
C. Deziel
S. Donnelly
J. Ethier
A. Fine
G. Ganz
M. Goldstein
J. Kappel
G. Karr
S. Langlois
D. Mendelssohn
N. Muirhead
B. Murphy
G. Pylpchuk
E. Toffelmire
Author Affiliation
Division of Nephrology, Memorial University of Newfoundland, Canada.
Source
Clin Nephrol. 2002 Oct;58(4):282-8
Date
Oct-2002
Language
English
Publication Type
Article
Keywords
Adult
Age Factors
Aged
Canada
Creatinine - urine
Cross-Sectional Studies
Diabetes Mellitus - metabolism - physiopathology - therapy
Female
Food Habits
Glomerular Filtration Rate - physiology
Health Surveys
Humans
Kidney Failure, Chronic - metabolism - physiopathology - therapy
Male
Middle Aged
Prospective Studies
Renal Dialysis
Serum Albumin - metabolism
Treatment Outcome
Urban health
Abstract
The current growth in end-stage kidney disease populations has led to increased efforts to understand the impact of status at dialysis initiation on long-term outcomes. Our main objective was to improve the understanding of current Canadian nephrology practice between October 1998 and December 1999.
Fifteen nephrology centers in 7 provinces participated in a prospective data collection survey. The main outcome of interest was the clinical status at dialysis initiation determined by: residual kidney function, preparedness for chronic dialysis as measured by presence or absence of permanent peritoneal or hemodialysis access, hemoglobin and serum albumin. Uremic symptoms at dialysis initiation were also recorded, however, in some cases these symptom data were obtained retrospectively.
Data on 251 patients during 1-month periods were collected. Patients commenced dialysis at mean calculated creatinine clearance levels of approximately 10 ml/min, with an average of 3 symptoms. 35% of patients starting dialysis had been known to nephrologists for less than 3 months. These patients are more likely to commence without permanent access and with lower hemoglobin and albumin levels. Even of those known to nephrologists, only 66% had permanent access in place.
Patients commencing dialysis in Canada appear to be doing so in relative concordance with published guidelines with respect to timing of initiation. Despite an increased awareness of kidney disease, a substantial number of patients continues to commence dialysis without previous care by a nephrologist. Of those who are seen by nephrologists, clinical and laboratory parameters are suboptimal according to current guidelines. This survey serves as an important baseline for future comparisons after the implementation of educational strategies for referring physicians and nephrologists.
PubMed ID
12400843 View in PubMed
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