Table 7.

Some of the most important factors conditioning patients’ late referral.

Reasons for Late Referral
Patients at risk of ESKD due to diabetes, hypertension, and ischemic heart disease are often referred late by their physicians, who are mainly concerned about the primary disease
Lack of awareness by general practitioners on the recognition that chronic diseases such as diabetes, hypertension, and cardiomyopathy represent a high-risk factor for CKD and ESKD
The consideration that elderly patients with chronic diseases may not survive long enough to develop ESKD
Lack of validated models that predict the progression of CKD, available for application at the patient’s bedside.
Patients’ unawareness of the complexity of their disease
Patients’ fear of dialysis
Socio-cultural inadequacy and difficulty in interacting with healthcare facilities due to logistic and/or language barriers