Nephrological Pretreatment Reduces Comorbidity in Dialysis Patients -- Results from the German BENEFIT Study Group.

Objective: The prognosis of patients on renal replacement therapy is critically determined by comorbidity. The purpose of the study was to evaluate the effect of nephrological care in the predialysis period on comorbidity parameters at time of initiation of hemodialysis: Methods: A prospective multicentric study evaluated 551 patients from 5 different regions (each more than 100 patients) in Germany consecutively at dialysis initiation. A questionnaire asked for intensity of predialytic nephrology care, clinical and biochemical parameters related to comorbidity. Results: Patients (n = 551) demographical data and diagnosis of renal failure are: diabetes mellitus (31%), hypertension/ nephrosclerosis (22%), glomerulonephritis (17%), others (30%). Cause of renal failure Age (y) Gender (M%) Nephr. Care (%) Diabetes mellitus 67 49 30 Hypertension/Sclerosis 70 62 33 Glomerulonephritis 57 66 55 Nephrological pretreatment vs. standard care had the following effects on biochemistry parameters: serum creatinine 7.0 vs 7.9 mg/dl, serum urea 206 vs 228 mg/dl, hemoglobin concentration 10.1 vs 9.5 g/dl; the frequencies of comorbidity parameters or cotreatment were: timely and electively dialysis initiation 84 vs 38%, hospitalisation during dialysis initiation 11 vs 18 days, hypertension 93 vs 83%, left ventricular hypertrophy 51 vs 67%, cardiovascular disease 24 vs 33%, malnutrition 24 vs 60%, erythropoietin treatment 58 vs 8%, iron supplementation 58 vs 5%, vitamin D therapy 78 vs 11%, acidosis therapy 60 vs 24%. Conclusions: The study shows that frequent and intensive nephrological care in the predialysis period minimizes the extent of comorbidity factors at dialysis initiation. Patients with glomerulonephritis are younger and receive more intensive nephrological care than diabetic or hypertensive patients. Therefore, prognosis of kidney patients should be significantly improved by providing routinely nephrological care already in the predialysis period. [ABSTRACT FROM AUTHOR]