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Outcomes in Patients with Chronic Kidney Disease Referred Late to Nephrologists: A Meta-analysis

Micah R. Chan

Purpose The study purpose was to compare differences in mortality and the duration of hospitalization in patients with chronic kidney disease who are referred early versus late to nephrologists. Methods We searched English-language literature from 1980 through December 2005, along with national conference proceedings, the Web of Science Citation Index, and reference lists of all included studies. Twenty-two studies with a total sample size of 12,749 met inclusion criteria. Study Questions We intended to answer the following questions: What is the risk of mortality in end-stage renal disease patients who are referred to nephrologists late versus those referred early? What is the difference in the duration of hospitalization, at the initiation of renal replacement therapy, between end-stage renal disease patients who are referred late and those referred early? In addition, we analyzed differences in the following laboratory parameters at the initiation of renal replacement therapy in subjects referred late versus those referred early: serum creatinine; creatinine clearance; albumin; hemoglobin; and hematocrit.