Annals of African Medicine
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Year : 2020  |  Volume : 19  |  Issue : 1  |  Page : 47-52

Late referral and associated factors among chronic kidney disease outpatients in Southern Nigeria

1 Department of Medicine, Renal Unit, University of Benin Teaching Hospital, University of Benin, Benin City, Edo State, Nigeria
2 Kidney Care Centre, University of Medical Sciences, Ondo City, Ondo State, Nigeria

Correspondence Address:
Dr. Enajite I Okaka
Department of Medicine, Renal Unit, University of Benin Teaching Hospital, University of Benin, Benin City, Edo State
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/aam.aam_26_19

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Background: Chronic kidney disease (CKD) is a recognized noncommunicable disease that contributes to the global disease burden. Studies on late referral (LR) of CKD patients to the nephrologist have reported incidence rates of 22%–58% according to the definition of LR used. CKD patients who present late to the nephrologist tend to have poorer outcomes with increased morbidity and mortality. Aim: The aim of the study is to determine the prevalence of LR and associated factors among CKD outpatients. Materials and Methods: A cross-sectional observational study, in which CKD patients attending the renal outpatient clinic of two tertiary hospitals over a period of 6 months, were recruited. LR was defined as commencement of renal replacement therapy within 3 months after the first presentation to a nephrologist. Results: A total of 181 participants were recruited during the period of study; 114 were men. One hundred and twelve participants (61.8%) had stage 5 CKD, of which 97 had commenced maintenance hemodialysis. The prevalence of LR was 44.8% (81/181) (95% confidence interval: 37.4%–51.9%). Lack of funds was the most frequent reason given by participants who delayed after formal referral to a nephrologist. Being a known diabetic was associated with LR. Age, gender, level of education, occupation, being a known hypertensive, or known diabetic were not significant predictors of LR. Conclusion: Prevalence of LR is high. Education of medical practitioners, patients, and the general public on early symptoms and physical signs of kidney disease is required. Initiation of all-encompassing health insurance scheme is necessary to solve the problem of lack of funds for medical consultation and treatment.

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