Early Consultation May Not Improve Short-term Survival in Kidney Patients

Early Consultation May Not Improve Short-term Survival in Kidney Patients

Early consultation with specialists failed to help elderly patients with acute kidney damage survive longer, according to a study.

One reason is that many of those who see a nephrologist early may already have advanced stages of the disease.

The research, “Earlier nephrology consultation may not be associated with improved short-term survival of acute kidney injury in very elderly men,” was published in the online platform Clinical Interventions in Aging.

Previous studies suggested that patients who consulted a nephrologist late don’t live as long. The premise was that a specialist could spot signs of acute kidney injury early enough to put patients on a treatment regimen that could prolong their lives.

Chinese researchers compared the 90-day survival rates of patients at least 75 years old who got early consultations with the rates of patients who got late consultations.

Their retrospective cohort analysis covered 623 elderly kidney patients admitted to the Geriatric Department of the Chinese People’s Liberation Army General Hospital between January 2007 and December 2015.

Nephrologists evaluated 162, or 26 percent, of the patients.

Thirty-nine percent of patients developed acute kidney damage. A third died within 90 days. Nine — or 1.4 percent — were put on dialysis.

A number of patients who died had consulted a specialist early. But they had severe manifestations of the disease when they did, including oliguria, or low output of urine; higher serum creatinine, a sign of kidney-filtration problems; and higher blood urea nitrogen levels.

Researchers discovered delays of at least 48 hours in 59 nephrology consultations — 36.4 percent of the total.

Despite this, they found no association between delayed consultations and a higher death rate. In fact, the 90-day mortality rate was similar between those who got early and delayed consultations — 50.8% versus 44.7%.

Overall, the study indicated that elderly patients who were checked by a nephrologist had more severe cases of kidney disease and died sooner than those who had not been evaluated by a nephrologist. However, earlier nephrology consultation had no association with longer survival.

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Patricia holds her Ph.D. in Cell Biology from University Nova de Lisboa, and has served as an author on several research projects and fellowships, as well as major grant applications for European Agencies. She also served as a PhD student research assistant in the Laboratory of Doctor David A. Fidock, Department of Microbiology & Immunology, Columbia University, New York.

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