[Evaluation of the management of new kidney failure patients in Réunion (Do what I say, but don't do what I do!)]

Abstract

The aim of this study was to describe the new patients with chronic renal failure (CRF), from a nephrology unit, during a 1-year period. This analysis of recruitment allowed us to describe the "preventive treatments" initiate before and after the first contact with a nephrology unit.

Population and methods: The medical records from patients coming for the first time for consultation or hospitalisation from 1.1.98 to 31.12.98 and with CRF (creatinine for men > 120 mumol/l, creatinine for women > 95 mumol/l) were retrospectively analysed.

Results: 98 patients (54 women and 44 men), among 248 new records (among a total of 2724 consultations and 948 hospitalizations) had a CRF. 76 patients (78%) had already a estimated clearance < 30 ml/min. 50% of the patients were sent from a general practitioner; 50% were diabetics; 30% were sent for a CRF discovered in a systematic evaluation. 26 patients arrived with at least one "preventive treatment". After their visit in nephrology, 48 more patients benefited from at least one "preventive treatment". 16 patients had no recommendations. 13 patients were hospitalised after the first consultation. 21 patients were put on dialysis immediately, 7 more in the first year, 7 died during the first hospitalisation.

Conclusion: Patients with CRF are coming too late in nephrology (median creatinine 300 mumol/l), with a poor prognosis (7% death and 29% dialysis in 1 year) with no "preventive treatment" except symptomatic (hypertension). Furthermore, a big effort has to be done by the nephrologists to initiate the "preventive treatment" from the very first contact with patients with CRF.