Trends in nephrology referral patterns for patients with chronic kidney disease: Retrospective cohort study

• Published in: PloS one Vol. 17; no. 8; p. e0272689
• Main Authors: Ghimire, Anukul, Ye, Feng, Hemmelgarn, Brenda, Zaidi, Deenaz, Jindal, Kailash K, Tonelli, Marcello A, Cooper, Matthew, James, Matthew T, Khan, Maryam, Tinwala, Mohammed M, Sultana, Naima, Ronksley, Paul E, Muneer, Shezel, Klarenbach, Scott, Okpechi, Ikechi G, Bello, Aminu K
• Format: Journal Article
• Language: English
• Published: San Francisco Public Library of Science 11.08.2022; Public Library of Science (PLoS)
• Subjects: Ambulatory care; Angiotensin; Beta blockers; Biology and Life Sciences; Care and treatment; Chronic kidney failure; Cohort analysis; Creatinine; Epidermal growth factor receptors; Glomerular filtration rate; Health care; Health hazards; Hematuria; Hospitalization; Internal medicine; Kidney diseases; Kidneys; Laboratories; Medical referrals; Medicine and Health Sciences; Mortality; Nephrology; Patient outcomes; People and places; Peritoneal dialysis; Primary care; Quality control; Regression analysis; Renal failure; Renin; Transplants & implants; Trends; Urine; Canada; Alberta Canada
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0272689

Information on early, guideline discordant referrals in nephrology is limited. Our objective was to investigate trends in referral patterns to nephrology for patients with chronic kidney disease (CKD). Retrospective cohort study of adults with [greater than or equal to]1 visits to a nephrologist from primary care with [greater than or equal to]1 serum creatinine and/or urine protein measurement <180 days before index nephrology visit, from 2006 and 2019 in Alberta, Canada. Guideline discordant referrals were those that did not meet [greater than or equal to]1 of: Estimated glomerular filtration rate (eGFR) < 30 mL/min/1.73m.sup.2, persistent albuminuria (ACR [greater than or equal to] 300 mg/g, PCR [greater than or equal to] 500 mg/g, or Udip [greater than or equal to] 2+), or progressive and persistent decline in eGFR until index nephrology visit ([greater than or equal to] 5 mL/min/1.73m.sup.2). Of 69,372 patients with CKD, 28,518 (41%) were referred in a guideline concordant manner. The overall rate of first outpatient visits to nephrology increased from 2006 to 2019, although guideline discordant referrals showed a greater increase (trend 21.9 per million population/year, 95% confidence interval 4.3, 39.4) versus guideline concordant referrals (trend 12.4 per million population/year, 95% confidence interval 5.7, 19.0). The guideline concordant cohort were more likely to be on renin-angiotensin system blockers or beta blockers (hazard ratio 1.14, 95% confidence interval 1.12, 1.16), and had a higher risk of CKD progression (hazard ratio 1.09, 95% confidence interval 1.06, 1.13), kidney failure (hazard ratio 7.65, 95% confidence interval 6.83, 8.56), cardiovascular event (hazard ratio 1.40, 95% confidence interval 1.35,1.45) and mortality (hazard ratio 1.58, 95% confidence interval 1.52, 1.63). A significant proportion nephrology referrals from primary care were not consistent with current guideline-recommended criteria for referral. Further work is needed to identify quality improvement initiatives aimed at enhancing referral patterns of patients with CKD.