45 Silmitasertib mouse examined the outcomes in patients with CKD referred late to a nephrologists.

The analysis did not distinguish between the cause of CKD nor conduct sub group analyses for diabetes. Overall, 20 studies (total sample size 12 749) examined the effect of late referral met inclusion. The definition of late referral varied from 1 month to 6 months. There was a significantly increased overall mortality in the late referral group compared with the early referral group (relative risk 1.99 95% CI: 1.6–2.39) and a significantly longer duration of hospital stay. However, the mean serum creatinine and creatinine clearance at time of referral were not significantly different between the groups. Cass et al.,46 investigated the association between area level measures of socioeconomic disadvantage Selleckchem MLN8237 and the proportion of ESKD patients who were referred late for renal replacement therapy. The analysis, which utilized the ANZDATA database, considered the timing of referral to a nephrologists and the postcode of residence at the start of treatment. Late referral was defined as those who required dialysis within 3 months of referral. The analysis was restricted to capital cities and excluded overseas visitors and those where ESKD was caused by disease with very short course. The ABS Statistical Sub-Division (SSD) level socioeconomic data from the 1996 census was used for the assessment. Of the total of 3334 patients (April 1995 – December 1998),

889 (26.7%) were found to have been referred late with a high variability between

SSDs. There was a significant correlation between late referral and disadvantage (r = 0.36, P = 0.01), with a higher proportion of late referral being associated Calpain with the more disadvantaged regions. Areas with higher incidence of ESKD in population terms were also areas where a higher proportion of patients were referred late. Issues of access, availability and quality of care are all potentially relevant to late referral. Disadvantaged areas had both an increased population burden of ESKD and a greater risk of delayed access to specialist renal services which is then associated with a poorer outcome. The study concludes that despite an overall improvement in the prevention and care of chronic diseases, with regard to chronic renal failure, there is a failure to address the needs of general practitioners and the public especially in disadvantaged areas. Of interest, late referral was found not to be related to geographical access to dialysis units.46 Overland et al. analysed information on the number of diabetic individuals and number of services for selected Medicare item codes by NSW postcodes using the Health Insurance Commission data file.47 The analysis was conducted for the 1996 calendar year and indicated that people at most disadvantage were less likely to be under the care of a GP (OR 0.41 0.40–0.41) or consultant physician (0.50 0.48–0.53) despite this group having the highest prevalence of diabetes.