Improvement in clinical outcome by early nephrology referral in type II diabetics on maintenance peritoneal dialysis

Objectives: To evaluate the influence of early nephrology referral on clinical outcome in type II diabetes mellitus patients on maintenance peritoneal dialysis (PD). Design: This is a retrospective study in a single University Hospital in Taiwan. Patients: This study analyzed the type II diabetic patients entering our PD program from February 1988 to June 2000. Patients that were presented to a nephrologist more than 6 months before starting dialysis were defined as early referrals (ER). Patients were considered late referrals (LR) if they were transferred to the nephrology department within 6 months before initial dialysis. Main Outcome Measures: Patient survival and technique survival curves were derived from Kaplan-Meier analysis and were compared using the Cox-Mantel log rank test. Covariates were analyzed with Cox proportional hazards model. Results: 52 type II diabetic patients were enrolled in this study: 16 in the ER group and 36 in the LR group. Patient survival was better in the ER group than in the LR group {relative risks [exp(coef)] 0.42; 95% confidence interval 0.152 - 0.666; p < 0.05}. The improved survival in the ER group was independent of age at dialysis, good glycemic control, and residual renal function, as indicated in the multivariate analysis with stepwise regression by Cox proportional hazards model. The ER group was also associated with better technique survival. Conclusions: These results suggest that early nephrology referral before initiating dialysis is associated with improved long-term clinical outcome in type II diabetics on maintenance PD.