TY  - JOUR
T1  - A defense of early renal referral: Preventing progression to end-stage renal disease
AU  - Hirsch S
Y1  - 2011/12/12
N1  - 10.1001/archinternmed.2011.584
JO  - Archives of Internal Medicine
SP  - 2064
EP  - 2065
VL  - 171
IS  - 22
N2  - 
The timing of renal referral should not be viewed as a “do or do not,” “one-rule-fits-all” issue. Much depends on the nature of an internal medicine practice and the experience of any particular internist with CKD issues. There are at least 2 features of CKD treatment that are inarguably important: (1) slowing down CKD progression via proper blood pressure control (with renin-angiotensin system inhibitors for proteinuric patients, arguably adjusted based on urine protein excretion rates2- 4) and (2) having a proper access in place at the time of dialysis initiation. If an internist can achieve a systolic blood pressure of 130 mm Hg or less in a patient with CKD (perhaps ≤120-125 mm Hg for proteinuric patients),2- 4 achieve significant reduction in proteinuria, identify and protect potential fistula veins, find the proper timing for access referral, discuss various modes of dialytic therapy, make informed recommendations, identify a knowledgeable surgeon, then early renal referral may be unnecessary. However, some internists will not be as successful or even comfortable in those efforts.

SN  - 0003-9926
M3  - doi: 10.1001/archinternmed.2011.584
UR  - http://dx.doi.org/10.1001/archinternmed.2011.584
ER  -