Quality of care for persons with diabetic nephropathy: timeliness of first referral to nephrologist.

The aim of the present study was to assess opinions of diabetes-interested nephrologists in Europe as to the appropriate timing for a first referral to a nephrologist of a person with signs of diabetic kidney disease and to compare these opinions to guideline recommendations and to actual clinical findings in patients referred to the same nephrologists. Fifty-one nephrologists from 15 countries responded to a questionnaire and provided information on 280 patients referred to them. Nearly all nephrologists favoured a first referral earlier than recommended by the St. Vincent Declaration guidelines, 97% of responders preferring a first referral at the latest at a serum creatinine of 150 micromol/l. However, the clinical findings showed that the majority of patients are referred not only later than favoured by the nephrologists, but also much later than guideline recommendations, ca 50% of patients having entered renal replacement therapy within 3 months after first referral. The present results suggest that wide discrepancies exist between opinions on the appropriate time for a first referral, guideline recommendations, and actual clinical findings at the time of first referral. To approach the targets of the St. Vincent Declaration, one of which is to reduce the number of patients entering renal replacement therapy due to diabetic kidney disease by one third, delivery of diabetes care needs to be improved. Research on the actual outcomes of different methods for organizing delivery of care may contribute much to improving quality of life for people with diabetic kidney disease.