BMC nephrology · 2026
Timing of renal coordinator referral and risk of unplanned dialysis initiation in advanced chronic kidney disease: a retrospective cohort study.
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Tiew H W, Kong Cathrine M C, Renaud Claude J, Teoh Selene T Y, Saifful Sri F B B, Ho Janice T Z, Lau S M, Tan Grace F L, Hsu John H Y, Wong S-Y, Teh Y K, Liu Allen Y L
Аннотация
BACKGROUND: Guideline recommendations on the timing of pre-dialysis care coordination remain largely consensus-based, with limited outcome data supporting specific referral thresholds. This study evaluated the association between the timing of referral to a Renal Coordinator (RC) and the risk of unplanned initiation of dialysis in patients with advanced chronic kidney disease (CKD).
METHODS: We performed a retrospective cohort study of 282 adults with end-stage kidney disease (ESKD) who were referred to RC at a tertiary hospital in Singapore between January 2022 and December 2024. All patients had established nephrology follow-up before initiation. The primary outcome was unplanned dialysis initiation, defined as initiation without permanent access. Logistic regression and Cox proportional hazards models were used to assess associations between eGFR at RC referral and unplanned initiation, adjusting for demographic and clinical covariates.
RESULTS: Of 282 patients evaluated, 237 (84.0%) completed the review by RC, while 45 defaulted post-referral. Unplanned initiation was more frequent among those reviewed at CKD Stage 5 than Stage 4 (78.8% vs. 62.5%). Referral within 90 days independently predicted unplanned initiation (OR 4.21, 95% CI 1.58-11.25). Conversely, RC review at an eGFR of 9-14 mL/min/1.73 m² was associated with a 55% lower risk (HR 0.45, 95% CI 0.22-0.91). Referral at higher or lower eGFR thresholds did not show a significant benefit.
CONCLUSION: Timely RC referral is associated with a reduction in unplanned dialysis. Initiating referral when eGFR is between 9 and 14 mL/min/1.73 m² may provide the necessary lead time to ensure a planned transition to renal replacement therapy.
METHODS: We performed a retrospective cohort study of 282 adults with end-stage kidney disease (ESKD) who were referred to RC at a tertiary hospital in Singapore between January 2022 and December 2024. All patients had established nephrology follow-up before initiation. The primary outcome was unplanned dialysis initiation, defined as initiation without permanent access. Logistic regression and Cox proportional hazards models were used to assess associations between eGFR at RC referral and unplanned initiation, adjusting for demographic and clinical covariates.
RESULTS: Of 282 patients evaluated, 237 (84.0%) completed the review by RC, while 45 defaulted post-referral. Unplanned initiation was more frequent among those reviewed at CKD Stage 5 than Stage 4 (78.8% vs. 62.5%). Referral within 90 days independently predicted unplanned initiation (OR 4.21, 95% CI 1.58-11.25). Conversely, RC review at an eGFR of 9-14 mL/min/1.73 m² was associated with a 55% lower risk (HR 0.45, 95% CI 0.22-0.91). Referral at higher or lower eGFR thresholds did not show a significant benefit.
CONCLUSION: Timely RC referral is associated with a reduction in unplanned dialysis. Initiating referral when eGFR is between 9 and 14 mL/min/1.73 m² may provide the necessary lead time to ensure a planned transition to renal replacement therapy.