Determinants and Consequences of Delayed Nephrology Referral in CKD Patients in Pakistan

Background: Timely nephrology referral is important for the evaluation and management of chronic kidney disease (CKD), yet delayed referral remains common in resource-limited settings. Objective: To identify demographic and clinical factors associated with delayed nephrology referral and examine referral timing in relation to renal and biochemical characteristics and the interval to dialysis initiation. Methods: This cross-sectional study included 179 adults with CKD evaluated at a tertiary nephrology unit in Peshawar, Pakistan, between December 2023 and March 2024. Patients were categorized as early (>6 months before dialysis), late (3–6 months), or ultra-late (<3 months) referrals. Demographic, socioeconomic, clinical, laboratory, and referral data were analyzed using descriptive statistics, group comparisons, and univariate logistic regression. Results: Of 179 patients, 60 (33.5%) were referred to early, 16 (8.9%) late, and 103 (57.5%) ultra-late. Late/ultra-late referral was associated with older age, male sex, rural residence, and impaired ambulation. Compared with early referral, late/ultra-late referral was characterized by higher serum creatinine, blood urea nitrogen, potassium, HbA1c and lower eGFR and sodium (all p<0.001). Male sex (OR 2.63, 95% CI 1.36–5.07) and rural residence (OR 5.54, 95% CI 2.71–11.33) were associated with greater odds of delayed referral. Conclusion: Delayed nephrology referral was common and was associated with demographic disparities, poorer kidney function, and an adverse biochemical profile at specialist assessment