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

Background. 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 poten-tially have been detected earlier because of increases in pa-tients ’ general hospital activity. Methods. A cohort of patients starting dialysis in the English NHS (National Health Service) during 2010/11 was approxi-mated using hospital administrative data. The time between first recorded contact with a consultant nephrologist and start-ing 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. Results. A cohort of 3928 patients was detected. One-thir