THE REFERRAL PATTERN OF END-STAGE RENAL DISEASE PATIENTS AND THE INITIATION OF DIALYSIS: A EUROPEAN PERSPECTIVE

D esPite impressive progress in the medical care of end-stage renal disease (ESRD) patients, ESRD is still associated with an unacceptably high mortality rate. To improve the management ofESRD patients, both medical and non medical problems should be addressed (1). It is conceivable that adequate pre-dialysis programs can improve the outcomes provided that patients are referred early to the renal unit and that sufficient resources are available. The latter condition to some extent depends on the health care structure of a given society (2). The present paper focuses on one important determinant ofESRD treatment in several European countries: the influence that the referral pattern ofESRD patients to the renal units has on the choice oftreatment modality, the clinical status of the patients at initiation of dialysis, and patient outcome