Pre-dialysis hospital use and late referrals in incident dialysis patients in England: a retrospective cohort study

Timely referral to specialist kidney care can improve outcomes for patients and delay the onset of dialysis, yet late referral (LR) remains a problem in many countries. We aimed to estimate the proportion of LRs that could potentially have been detected earlier because of increases in patients' general hospital activity. A cohort of patients starting dialysis in the English NHS (National Health Service) during 2010/11 was approximated using hospital administrative data. The time between first recorded contact with a consultant nephrologist and starting dialysis was used to categorize the timeliness of referral. Monthly rates of inpatient activity prior to starting dialysis for both referral types were compared with the national average. A cohort of 3928 patients was detected. One-third (34%) of the cohort started dialysis