BACKGROUND AND AIM
The aim of the study is to investigate the baseline epidemiological and clinical profiles of patients at first referral to a nephrology clinic.
PATIENTS AND METHODS
Cross-sectional study of all outpatients newly referred to a nephrology clinic over 12 months.A total of 656 patients was examined (62.3 % males); mean age 62.1±18.2 years (13-95 years, modal value 72). Serum creatinine and urinalysis had been determined prior to referral in 605/656 and 423/656 patients, respectively.
Seventy-one percent of patients were referred by a primary care physician, 19 % by an internist and 9.6 % for nephrologic follow-up after hospitalization. Referral indications included renal impairment (63.6 %), urinary abnormalities (42.8 %), and morphological alterations (16.3 %). Seventy % of patients had hypertension, 39.2 % heart disease, 22.3 % arterial-vascular disease, 26 % diabetes, 26.4 % urologic disease and 16.8 % malignancies (mean number of comorbidities 3.0±2.0). Serum creatinine ranged 0.43-7.75 mg/dl, mean 1.5±0.8, and the eGFR (MDRD simplified formula) ranged 6.9-192.2, mean 53±27 ml/min/1.73m²; CKD stage 1: 12.1%; stage 2: 21.7 %; stage 3a: 23.8 %, stage 3b 25.5 % and CKD stages 4&5: 17%. Thirty point four % of patients, classified as CKD stage 2 or 3a(GFR <90->45 ml/min/1.73 m 2), had a normal renal function after adjustement of eGFR to their age, assuming a reduction of 1 ml/min/1.73 m 2 per year over the age of 40 years. Abdominal ultrasounds had been performed on 396/656 patients.Renal dimensions were measured only in 25.3 %. Nineteen point four % had abnormalities of echogenicity, 21.5 % cysts, 8 % stones, 2.6 % focal spaceoccupying lesions and 3.9 % urinary tract dilation.
The majority of patients are referred to a nephrology clinic by their doctor, due to impaired eGFR, often without urinalysis.They are elderly patients, with a high incidence of arterial hypertension and cardiovascular and metabolic comorbidities.Possibly, many aged patients are misclassified for CKD stage, if eGFR is not adjusted to age.