Kidney disease patients are at a much increased risk of death when they have delays getting to a specialist, a Johns Hopkins-led study shows. Delays occur more often among black males, the uninsured and those who have multiple illnesses.

Results of the study, published in the Sept. 17 issue of the Annals of Internal Medicine, show that a third of chronic kidney disease patients were evaluated by a nephrologist only four months before having to start life-saving dialysis treatment. Those evaluated late were more likely to die within two years after starting dialysis. Delayed evaluation typically is associated with a higher risk of unplanned first dialysis and complications as well as increased hospital costs and length of stay.

While the study did not examine reasons for the delay in getting specialty care, senior author Neil R. Powe, M.D., M.P.H., M.B.A., says these probably include poor access to primary care, delayed or absent referral to a specialist from a primary care doctor and patients' lack of information about the importance of early intervention.

"There also are many people who have chronic kidney disease and may not know it, so they may not be under a physician's care," says Powe, director of Hopkins' Welch Center for Prevention, Epidemiology and Clinical Research. "We need to get the condition on the radar screen, especially when there's a medical history of high blood pressure or diabetes, so both patients and physicians are more aware of the consequences and opportunities to intervene. These patients should be under the care of a doctor and should talk to their doctors about seeing a nephrologist before their disease progresses to
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Contact: Karen Blum
kblum@jhmi.edu
410-955-1534
Johns Hopkins Medical Institutions
16-Sep-2002