Outcomes in patients with chronic kidney disease referred late to nephrologists: A meta-analysis

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. RESULTS: There was significantly increased overall mortality in the late referral group as compared with the early referral group ( relative risk 1.99; 95% confidence interval [CI], 1.66 to 2.39, P <.0001). The duration of hospital stay, at the time of initiation of renal replacement therapy, was greater in the late referred group by an average of 12 days ( 95% CI, 8.0 to 16.1, P=.0007). Significant heterogeneity was detected for both outcomes. CONCLUSION: Timing of referral emerged to be a significant factor impacting homogeneity in the mortality outcome. Our results suggest significantly higher mortality and increased early hospitalization of chronic kidney disease subjects referred late to nephrologists as compared with earlier referred subjects. (c) 2007 Elsevier Inc. All rights reserved.