Late referral and associated factors among chronic kidney disease outpatients in Southern Nigeria

Background: Chronic kidney disease (CKD) is a recognized noncommunicable disease that contributes to the global disease burden. Studies on late referral (LR) of CKD patients to the nephrologist have reported incidence rates of 22%-58% according to the definition of LR used. CKD patients who present late to the nephrologist tend to have poorer outcomes with increased morbidity and mortality. Aim: The aim of the study is to determine the prevalence of LR and associated factors among CKD outpatients. Materials and Methods: A cross-sectional observational study, in which CKD patients attending the renal outpatient clinic of two tertiary hospitals over a period of 6 months, were recruited. LR was defined as commencement of renal replacement therapy within 3 months after the first presentation to a nephrologist. Results: A total of 181 participants were recruited during the period of study; 114 were men. One hundred and twelve participants (61.8%) had stage 5 CKD, of which 97 had commenced maintenance hemodialysis. The prevalence of LR was 44.8% (81/181) (95% confidence interval: 37.4%-51.9%). Lack of funds was the most frequent reason given by participants who delayed after formal referral to a nephrologist. Being a known diabetic was associated with LR. Age, gender, level of education, occupation, being a known hypertensive, or known diabetic were not significant predictors of LR. Conclusion: Prevalence of LR is high. Education of medical practitioners, patients, and the general public on early symptoms and physical signs of kidney disease is required. Initiation of all-encompassing health insurance scheme is necessary to solve the problem of lack of funds for medical consultation and treatment.