Late diagnosis of chronic renal failure and mortality on maintenance dialysis

BACKGROUND.: Recent observations in our country have shown that late diagnosisof chronic renal failure (CRF) is an important cause of latereferral and late commencement of maintenance dialysis. We prospectivelyinvestigated the influence of late diagnosis of CRF on patientmortality during dialysis therapy. METHODS.: Among 184 consecutive patients with non-diabetic end-stage renaldisease starting chronic dialysis at the Federal UniversityHospital in the city of So Paulo, 106 had a late diagnosis ofCRF (less than 1 month before starting dialysis) and 78 hadan early diagnosis. During the first 6 months of dialysis treatment,patient survival was compared in the two groups, using the Kaplan-Meiermethod and the Cox proportional hazards model. RESULTS.: Six-month patient survival rate was lower in the late than inthe early diagnosis group (69% versus 87%, P<0.01). In thelate diagnosis group, the hazard ratio of mortality was 2.77(95% C1, 1.36–5.66) times that of the early diagnosisgroup. In a multivariate analysis, after adjusting for age,comorbid illness, and serum biochemical measurements, time ofdiagnosis did not remain significantly associated with mortalityrisk. In this analysis, age, pulmonary infection, and low serumalbumin were significant predictors of mortality. CONCLUSIONS.: Patients with a late diagnosis have a higher mortality riskduring the first 6 months of maintenance dialysis. This increasedrisk is related to comorbid conditions, some of which couldbe prevented by predialysis care. Interventions to promote earlydiagnosis of CRF and adequate predialysis follow-up need tobe evaluated if the survival of patients with chronic renalfailure is to improve.