Specialist Evaluation in Chronic Kidney Disease: Too Little, Too Late

Editorials17 September 2002Specialist Evaluation in Chronic Kidney Disease: Too Little, Too LateNorman G. Levinsky, MDNorman G. Levinsky, MDSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-137-6-200209170-00016 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Maintenance of patients with end-stage renal disease (ESRD) on long-term dialysis is a triumph of modern medicine. In the United States alone, more than 250 000 persons with ESRD, who otherwise would have died, enjoy life—usually of good quality—because of the availability of hemodialysis and peritoneal dialysis. Yet this triumph has a tragic flaw: The lifespan of dialysis patients remains abnormally short. Only about one third survive 5 years. Even patients who start dialysis in their 40s have no more than a 50% chance to live 5 more years (1).Nephrologists caring for patients receiving long-term dialysis have studied and ...References1. United States Renal Data System. 2001 Annual Data Report. Bethesda: National Institute of Diabetes and Digestive and Kidney Diseases; 2001:498. Google Scholar2. Obrador GT, Pereira BJ. Early referral to the nephrologist and timely initiation of renal replacement therapy: a paradigm shift in the management of patients with chronic renal failure. Am J Kid Dis. 1998;31:398-417. PMID: 9506677 CrossrefMedlineGoogle Scholar3. Ismail N, Neyra R, Hakim R. The medical and economical advantages of early referral of chronic renal failure patients to renal specialists. Nephrol Dial Transplant. 1998;13:246-50. PMID: 9509429 CrossrefMedlineGoogle Scholar4. . Morbidity and mortality of renal dialysis: an NIH Consensus Conference Statement. Consensus Development Conference Panel. Ann Intern Med. 1994;121:62-70. PMID: 8198352 LinkGoogle Scholar5. Kinchen KS, Sadler J, Fink N, Brookmeyer R, Klag MJ, Levey AS, et al . The timing of specialist evaluation in chronic kidney disease and mortality. Ann Intern Med. 2002;137:479-86. LinkGoogle Scholar6. Remuzzi G, Ruggenenti P, Perico N. Chronic renal diseases: renoprotective benefits of renin–angiotensin system inhibition. Ann Intern Med. 2002;136:604-15. PMID: 11955029 LinkGoogle Scholar7. Jafar TH, Schmid CH, Landa M, Giatras I, Toto R, Remuzzi G, et al . Angiotensin-converting enzyme inhibitors and progression of nondiabetic renal disease. A meta-analysis of patient-level data. Ann Intern Med. 2001;135:73-87. PMID: 11453706 LinkGoogle Scholar8. Ritz E, Koch M, Fliser D, Schwenger V. How can we improve prognosis in diabetic patients with end-stage renal disease? Diabetes Care. 1999;22 Suppl 2 B80-83. PMID: 10097905 MedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Current Author Address: Norman G. Levinsky, MD, Boston University Medical Center, 751 Albany Street, L-102, Boston, MA 02118. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoThe Timing of Specialist Evaluation in Chronic Kidney Disease and Mortality Kraig S. Kinchen , John Sadler , Nancy Fink , Ronald Brookmeyer , Michael J. Klag , Andrew S. Levey , and Neil R. 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Levey, MD, Josef Coresh, MD, PhD, Ethan Balk, MD, MPH, Annamaria T. Kausz, MD, MS, Adeera Levin, MD, Michael W. Steffes, MD, PhD, Ronald J. Hogg, MD, Ronald D. Perrone, MD, Joseph Lau, MD, and Garabed Eknoyan, MDStandards of Medical Care for Patients With Diabetes MellitusDiabetes Mellitus 17 September 2002Volume 137, Issue 6Page: 542-543KeywordsElderlyErythropoietinMedical dialysisMorbidityMortalityPatientsPrimary care physiciansRenal critical careRenal diseasesRenal failure ePublished: 17 September 2002 Issue Published: 17 September 2002 Copyright & PermissionsCopyright © 2002 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...