Trends in nephrology referral patterns for patients with chronic kidney disease: Retrospective cohort study.
Journal
PloS one
ISSN: 1932-6203
Titre abrégé: PLoS One
Pays: United States
ID NLM: 101285081
Informations de publication
Date de publication:
2022
2022
Historique:
received:
30
05
2022
accepted:
25
07
2022
entrez:
11
8
2022
pubmed:
12
8
2022
medline:
16
8
2022
Statut:
epublish
Résumé
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 ≥1 visits to a nephrologist from primary care with ≥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 ≥1 of: Estimated glomerular filtration rate (eGFR) ˂ 30 mL/min/1.73m2, persistent albuminuria (ACR ≥ 300 mg/g, PCR ≥ 500 mg/g, or Udip ≥ 2+), or progressive and persistent decline in eGFR until index nephrology visit (≥ 5 mL/min/1.73m2). 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.
Identifiants
pubmed: 35951609
doi: 10.1371/journal.pone.0272689
pii: PONE-D-22-15659
pmc: PMC9371302
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e0272689Subventions
Organisme : CIHR
Pays : Canada
Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
Références
Am J Kidney Dis. 2001 Nov;38(5):1122-8
pubmed: 11684571
BMJ Open. 2020 Feb 16;10(2):e032838
pubmed: 32066603
Aust J Gen Pract. 2018 Jan-Feb;47(1-2):58-62
pubmed: 29429319
Am J Kidney Dis. 2003 Feb;41(2):310-8
pubmed: 12552491
BMC Nephrol. 2008 Feb 25;9:3
pubmed: 18298850
Kidney Int. 2009 Aug;76(3):318-23
pubmed: 19436331
Ann Intern Med. 2009 May 5;150(9):604-12
pubmed: 19414839
Lancet. 2012 Jan 14;379(9811):165-80
pubmed: 21840587
BMC Med Inform Decis Mak. 2015 Apr 17;15:31
pubmed: 25886580
Cochrane Database Syst Rev. 2014 Jun 18;(6):CD007333
pubmed: 24938824
Healthc Manage Forum. 2017 Jul;30(4):190-192
pubmed: 28929870
Can J Kidney Health Dis. 2019 Oct 04;6:2054358119879778
pubmed: 31632683
Lancet. 2015 May 16;385(9981):1975-82
pubmed: 25777665
Aust Fam Physician. 2016 Apr;45(4):223-8
pubmed: 27052141
Int J Popul Data Sci. 2021 Oct 21;6(1):1672
pubmed: 34734125
Hypertension. 2009 Dec;54(6):1423-8
pubmed: 19858407
Can J Kidney Health Dis. 2014 May 22;1:9
pubmed: 25780604
Nephrol Dial Transplant. 2008 Dec;23(12):3845-50
pubmed: 18632591
Can J Kidney Health Dis. 2017 Aug 09;4:2054358117722782
pubmed: 28835850
BMJ Open. 2022 Apr 21;12(4):e055456
pubmed: 35450902
Nephrol Dial Transplant. 2004 Jul;19(7):1808-14
pubmed: 15199194
QJM. 2009 Jun;102(6):415-23
pubmed: 19349287
Kidney Int. 2011 Jan;79(2):210-7
pubmed: 20927036
Am J Kidney Dis. 2015 Feb;65(2):177-205
pubmed: 25511161
Can J Kidney Health Dis. 2022 May 11;9:20543581221097456
pubmed: 35574262
BMC Nephrol. 2009 Oct 19;10:30
pubmed: 19840369
Can J Kidney Health Dis. 2020 Jun 02;7:2054358120924140
pubmed: 32547773
Can J Kidney Health Dis. 2018 Jan 23;5:2054358117753619
pubmed: 29399366
BMC Nephrol. 2021 Oct 6;22(1):332
pubmed: 34615462
CMAJ. 2007 Oct 23;177(9):1039-44
pubmed: 17954893
Ann Fam Med. 2005 May-Jun;3(3):209-14
pubmed: 15928223
Clin J Am Soc Nephrol. 2008 Nov;3(6):1902-10
pubmed: 18922986
JAMA. 2010 Mar 24;303(12):1151-8
pubmed: 20332400
JAMA Netw Open. 2019 Sep 4;2(9):e1910704
pubmed: 31483474
Clin J Am Soc Nephrol. 2011 Feb;6(2):334-43
pubmed: 21212420
BMC Nephrol. 2015 Mar 28;16:37
pubmed: 25885460
Chronic Dis Can. 2000;21(3):104-13
pubmed: 11082346
BMC Nephrol. 2012 Sep 10;13:108
pubmed: 22963236
Am J Public Health. 2003 Apr;93(4):635-41
pubmed: 12660210
Cochrane Database Syst Rev. 2008 Oct 08;(4):CD005471
pubmed: 18843691
CMAJ. 2012 Mar 20;184(5):E269-76
pubmed: 22331970
Kidney Int. 2015 Oct;88(4):859-66
pubmed: 26221754