The definition of late referral varies but usually entails starting some form of dialysis soon after a consult with the nephrologist is placed. This usually implies a permanent loss of renal function and initiation of renal replacement therapy as soon as possible..
Benefits of early referral to a nephrologist:
(1) starting an intervention that may reverse or slow the decline in renal function
(2) availability of a native arteriovenous (AV) fistula that has“matured” prior to starting hemodialysis, which usually takes about 4 months
(3) not needing to use an alternative form of vascular access
(4) ability to plan other interventions such as peritoneal dialysis or renal transplantation
(5) reduced complications and better quality of life
Factors affecting the timing of a referral:
(1) The speed at which renal function declines (acute vs chronic).
(2) The patient being lost to followup.
(3) Other comorbid conditions that may overshadow the decline in renal function.
