Coping with the CKD epidemic: the promise of multidisciplinary team-based care

Abstract

It is well known that late referral to a nephrologist is associated with many adverse outcomes [1–4], and indeed has been the subject of a recent review in this journal [5]. Some of the more important negative outcomes include more rapid onset of end-stage renal disease (ESRD), progression of co-morbid conditions such as anaemia and cardiovascular disease, suboptimal vascular access at initiation of dialysis, increased use of centre-based haemodialysis (HD), increased hospital utilization, increased cost and worse survival. The literature has many examples of suboptimal chronic kidney disease (CKD) care provided by primary care physicians prior to referral, and also shows clearly that care provided by nephrologists is better [6,7]. There is a consensus within the renal community that early referral is desirable [5,8–10].M