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Late referral to a nephrologist reduces access to renal transplantation

Overview of attention for article published in American Journal of Kidney Diseases, November 2003
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About this Attention Score

  • In the top 25% of all research outputs scored by Altmetric
  • Good Attention Score compared to outputs of the same age (79th percentile)

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1 blog
1 policy source


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Late referral to a nephrologist reduces access to renal transplantation
Published in
American Journal of Kidney Diseases, November 2003
DOI 10.1016/j.ajkd.2003.07.006
Pubmed ID

Alan Cass, Joan Cunningham, Paul Snelling, John Z. Ayanian


Primary care physicians frequently request consultation with a nephrologist late in the treatment of patients with chronic kidney disease (CKD). Between 25% and 40% of referred CKD patients need renal replacement therapy (RRT) within 3 months of referral to a nephrologist. Late referral is associated with higher morbidity and worse long-term survival rates. The authors examined the effect of late referral on access to renal transplantation. Data from the Australian end-stage renal disease (ESRD) registry (Australia and New Zealand Dialysis and Transplant Registry Database [ANZDATA]) regarding all ESRD patients aged 18 to 64, starting treatment between April 1995 and December 1998 were used. Excluding overseas visitors and patients commencing RRT outside Australia, the data encompassed 3,310 patients. Main outcome measures were: (1) acceptance onto a waiting list, (2) receipt of a transplant before March 31, 2000, and/or (3) receipt of a transplant during defined periods of RRT. Late referral patients were less likely to be put on the waiting list (odds ratio [OR], 0.49; 95% confidence intervals [CI], 0.41 to 0.59) or given a transplant (hazard ratio, 0.65; 95% CI, 0.55 to 0.77). Transplantation rates differed maximally during the first 3 months of RRT (OR, 0.21; 95% CI, 0.11 to 0.40) and were lower throughout RRT (OR in the period more than 2 years after commencing RRT, 0.67; 95% CI, 0.47 to 0.96). Primary care physicians should refer patients at risk for ESRD earlier than is current practice. To improve access to transplantation and to achieve optimal outcomes of ESRD management, greater collaboration will be needed between primary care physicians and nephrologists.

Mendeley readers

The data shown below were compiled from readership statistics for 40 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Slovenia 1 3%
Unknown 39 98%

Demographic breakdown

Readers by professional status Count As %
Student > Ph. D. Student 9 23%
Student > Master 9 23%
Student > Bachelor 5 13%
Professor 4 10%
Researcher 4 10%
Other 6 15%
Unknown 3 8%
Readers by discipline Count As %
Medicine and Dentistry 23 57%
Nursing and Health Professions 4 10%
Social Sciences 3 8%
Psychology 3 8%
Economics, Econometrics and Finance 1 3%
Other 2 5%
Unknown 4 10%

Attention Score in Context

This research output has an Altmetric Attention Score of 9. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 17 July 2020.
All research outputs
of 18,244,737 outputs
Outputs from American Journal of Kidney Diseases
of 4,337 outputs
Outputs of similar age
of 380,661 outputs
Outputs of similar age from American Journal of Kidney Diseases
of 76 outputs
Altmetric has tracked 18,244,737 research outputs across all sources so far. Compared to these this one has done well and is in the 83rd percentile: it's in the top 25% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 4,337 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 13.6. This one has gotten more attention than average, scoring higher than 62% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 380,661 tracked outputs that were published within six weeks on either side of this one in any source. This one has done well, scoring higher than 79% of its contemporaries.
We're also able to compare this research output to 76 others from the same source and published within six weeks on either side of this one. This one is in the 23rd percentile – i.e., 23% of its contemporaries scored the same or lower than it.