Factors Associated with Late Referral in End Stage Renal Disease Patients at Dr. Cipto Mangunkusumo Hospital

• Main Authors: Aida Lydia, Grecia Rachmaningrum, Hamzah Shatri, Pringgodigdo Nugroho
• Format: Article
• Language: Indonesian
• Published: Department of Internal Medicine, Faculty of Medicine Universitas Indonesia-Cipto Mangunkusumo Hospital 2020-06-01
• Series: Jurnal Penyakit Dalam Indonesia
• Subjects: late referral; end-stage renal disease; renal replacement therapy
• Online Access: http://jurnalpenyakitdalam.ui.ac.id/index.php/jpdi/article/view/433/234
• ISSN: 2406-8969; 2549-0621

Introduction. Timely referral to nephrologist is important in Chronic Kidney Disease (CKD) patients. Late referral has been proven increasing the morbidity and mortality rate. Factors affecting late referral are well known in western population. As a tertiary referral hospital where all patients are served by consultants, Dr. Cipto Mangunkusumo General Hospital (RSCM) do not have data regarding late referral of CKD patients. This study aimed to determine the proportion of late referral to nephrologist of CKD-End Stage Renal Disease (ESRD) patients in RSCM and its related factors. Methods. A cross-sectional study of 210 CKD-ESRD patients who started dialysis initiation in dialysis unit of Cipto Mangunkusumo General Hospital from April 2017 to January 2019. Late referral were defined as patients who were referred to nephrologist more than 6 months prior to dialysis. Independent variables consist of age, gender, education, income status, ambulation status, risk of comorbid disease, compliance and underlying of kidney disease. From the dialysis registry and medical record, then continued with follow up the subjects. Living subjects was given informed consent to perform a structured interview. The subjects who died and hard to contact, data were collect from medical record. Bivariate analysis was done using Chi-square methods, Fisher method is used as alternative. Significant variables will be further analyzed with logistic regression test. Results. From 210 subjects who undergo dialysis at the first time in Cipto Mangunkusumo Hospital, 189 patients were referred late (proportion 90%; 95% CI 86.2-93.7). From multivariate analysis, two main factors related to later referral were the assisted-ambulatory status (p=0.002; OR 6.71; 95% CI 2.02-22,32) and non-compliance (p=0.001; OR 7.42; IK 95% 2.33-23.62). Conclusions. The proportion of late referral of CKD-ESRD patients at Dr.Cipto Mangunkusumo General Hospital is 90%. Assisted-ambulatory status and non-compliance are related to late referral of CKD-ESRD patients. Further study is needed to know the role of other factors such as health care system and its implementation by physician.