Late Referral of Patients with End-stage Renal Disease from Community Hospitals in Northeast Thailand

Background and Aim: The delayed referral of end-stage renal disease (ESRD) patients to nephrologists is well established as a factor associated with increased morbidity and mortality. This study aimed to understand the factors contributing to late referrals (LRs) and their impact on outcomes. Materials and Methods: We conducted a retrospective cross-sectional study of 89 newly diagnosed patients with ESRD referred to Sakon Nakhon Hospital, a tertiary medical center in Northeast Thailand, spanning from October 2021 to September 2022. We compared demographic and clinical characteristics and assessed factors associated with LR and their subsequent outcomes. Results: All of ESRD patients, 59.6% were referred late. The primary cause of LR is patient-related factors, particularly related to their awareness of their condition (30.3%). Moreover, late referred patients exhibited a higher prevalence of uremic complications (59.6%) and required emergency dialysis (58.4%) more frequently. Remarkably, only 5.6% of all patients did not continue dialysis beyond 3 months. Furthermore, early mortality (5.6%) was observed exclusively in the late referred group. Conclusion: The identified causes of LR, such as patient unawareness and physician-related delays, pointed to areas that may benefit from targeted interventions to improve ESRD awareness and early intervention.