Since the introduction of automatic reporting of the eGFR and the introduction of a shared-care approach for general practitioners, the number of nephrology referrals has increased greatly in Australia. In fact, many patients are referred inappropriately. Whether this increase in referral of patients with stage 4 and stage 3 disease will translate to better pre-dialysis
care is yet to be determined. Early referral of patients with CKD should increase the number that are able to commence haemodialysis BGB324 with an AV fistula. Data from ANZDATA15 show that amongst Australian patients commencing dialysis between 2004 and 2007, those referred more than 3 months prior to the initiation of dialysis used an AV fistula as their first access in almost 50%, a tunnelled central venous catheter in a third and a non-tunnelled catheter in almost 20%. In contrast, of those referred within 3 months of commencing dialysis, less than 10% used an AV fistula as their first haemodialysis access, 50% a learn more tunnelled central venous catheter and approximately 40% a non-tunnelled catheter. This is important as 12 month survival was clearly better in patients
commencing dialysis with an AV fistula compared to those commencing with a central venous catheter. Late referral is a major reason for a suboptimal start to PD as well. For example, in the Alice Ho Miu Ling Nethersole Hospital in Hong Kong in 2007, almost one half of patients required dialysis prior to CAPD training; in 40% of these the reason was late referral. Current guidelines about the commencement of dialysis are based on relatively poor data. The main determinants of modality of dialysis at initiation are informed patient choice, the absence of medical and surgical contraindications and resource availability. Patient education and multidisciplinary pre-dialysis clinics are important components of pre-dialysis care. Early referral to a nephrologist should increase the number Fenbendazole receiving appropriate care prior to dialysis initiation, resulting in a greater use of permanent
access at the time of initiation and improved patient outcomes and survival. The Authors state that there is no conflict of interest regarding the material discussed in the manuscript. “
“Date written: June 2008 Final submission: June 2009 No recommendations possible based on Level I or II evidence. (Suggestions are based on Level III and IV evidence) There is currently no Level III or IV evidence examining the efficacy of specific dietary interventions in the management of anaemia in kidney transplant recipients. The following suggestions are based on opinion with reference to the evidence relating to the occurrence of anaemia in kidney transplant recipients. All adult kidney transplant recipients should be monitored for anaemia. Anaemia, defined as a haemoglobin concentration of <11–12 g/dL in women or <12–13 g/dL in men1,2 is common in patients with end-stage renal failure.