The first appointment with a nephrologist: Brazilian patients' demographic and kidney function characteristics. A retrospective study

• Published in: São Paulo medical journal Vol. 140; no. 3; pp. 366 - 371
• Main Authors: Samaan, Farid, Fernandes, Danilo Euclides, Kirsztajn, Gianna Mastroianni, Sesso, Ricardo
• Format: Journal Article
• Language: English
• Published: Brazil Associação Paulista de Medicina - APM 01.05.2022; Associação Paulista de Medicina
• Subjects: Appointment; Brazil - epidemiology; Chronic kidney disease; Demography; Humans; Hypertension - epidemiology; Kidney; MEDICINE, GENERAL & INTERNAL; Nephrologists; Nephrology; Primary health care; Proteinuria - epidemiology; Referral; Referral and Consultation; Renal insufficiency, chronic; Renal Insufficiency, Chronic - epidemiology; Renal Insufficiency, Chronic - therapy; Retrospective Studies; Brazil; Appointment; Nephrology; Chronic kidney disease; Renal insufficiency, chronic; Primary health care; Referral
• ISSN: 1516-3180; 1806-9460; 1806-9460
• DOI: 10.1590/1516-3180.2021.0194.R1.13082021

The number of nephrologists has risen slowly, compared with the prevalence of chronic kidney disease (CKD) in Brazil. Data on patients referred to nephrology outpatient clinics remains scarce. To determine the demographic and kidney function characteristics of patients at their first appointment with a nephrologist. Retrospective study conducted at three nephrology outpatient clinics (public and private services), in São Paulo, Brazil. From December 2019 to February 2020, we collected patient data regarding demographics, kidney function parameters and comorbidities. We then analyzed data on 394 patients who met a nephrologist for their first appointment. The main comorbidities were hypertension (63.7%), diabetes (33.5%) and nephrolithiasis (22.3%). Regarding CKD stages, 24.1%, 9.1%, 13.7%, 15.2%, 15.2% and 2.3% of the patients were in stages 1, 2, 3a, 3b, 4 and 5, respectively. Proteinuria was absent or mild, moderate and high in 17.3%, 15.2% and 11.7%, respectively; and 16.2% had not undergone previous investigation of serum creatinine or proteinuria (55.8%). For 17.5%, referral to a nephrologist occurred late. Patients in public services were older than those in private services (59 years versus 51 years, respectively; P = 0.001), more frequently hypertensive (69.7% versus 57.5%; P = 0.01) and reached a nephrologist later (22.4% versus 12.4%; P = 0.009). Referrals to a nephrologist were not being made using any guidelines for CKD risk and many cases could have been managed within primary care. Late referral to a nephrologist happened in one-fifth of the cases and more frequently in the public service.