Author Affiliations: Department of Medicine, Nephrology Associates of South Miami, Miami, Florida.
The recent article by Winkelmayer1 that appeared in the Archives in the August 8/22 issue brings forth questions that practicing nephrologists have worried about for decades. However it should be titled “How late referral fails to change early renal replacement therapy outcomes.” Outcomes for end-stage renal disease have not changed for the last 2 decades. Given the design of the study, which looked at fairly late referrals, the only parameters that showed improvement were anemia and vascular access placement.
Busse JC. Impact of Nephrologic Care in the Early Management of Chronic Kidney Disease. Arch Intern Med. 2011;171(22):2066–2067. doi:10.1001/archinternmed.2011.587
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