Factors influencing referral of all 304 patients who developed persistent renal failure during one year were studied in the stable Grampian population. The annual incidence of chronic renal failure (CRF) (creatinine≥300μmol/l) was 450/million of the population and of persistent advanced CRF (creatinine≥500μmol/l), 132/million. After excluding those aged<80 years and those with advanced malignancy, the corresponding incidence figures were 240/million/year and 81/million/year. Only 109 patients (35.8) were referred to a nephrologist Patients were divided according to age and coexisting disease into low, medium and high risk groups; 69of CRF patients in the low, 58in the medium, and 21in the high risk group were referred (100, 88and 37, respectively, of the patients with advanced CRF). Two-year patient survival in the low, medium and high risk groups was 100, 63and 27, respectively, in referred patients, and 100, 48and 14, respectively, in non-referred patients. This method of risk stratification identifies patients (particularly those with advanced CRF) likely to have a poor outcome irrespective of referral to a nephrologist. Earlier referral for interventions to delay the progress of the patients′renal and cornorbid illnesses has considerable implications for future planning and funding of renal s
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