Kidney Week

Abstract: FR-PO263

Impact of a Phone App on the Referral to Nephrology

Session Information

• CKD: Clinical, Outcomes, Trials - II
  October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 1902 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

• Oliva-Damaso, Nestor, Hospital Costa del Sol, Marbella, Spain

Nestor Oliva-Damaso,

• Oliva-Damaso, Elena, Hospital General Universitario de Gran Canaria Dr Negrin, Las Palmas, Spain

Elena Oliva-Damaso,

• Lopez, Francisca, Hospital Costa del Sol, Marbella, Spain

Francisca Lopez,

• Castilla, Maria Mar, Hospital Costa del Sol, Marbella, Spain

Maria Mar Castilla,

• Rodriguez-Perez, Jose C., University Hospital , Las Palmas Gran Canaria, Spain

Jose C. Rodriguez-Perez,

• Payan Lopez, Juan, Hospital Costa del Sol, Marbella, Spain

Juan Payan Lopez,

Background

Several factors might influence nephrology referral decisions by clinicians, including lack of training about guidelines regarding timing or indications. In the 21^st century tools as phone apps can make knowledge more accessible.

Methods

Prospective quasi-experimental study. We studied referral to nephrology in the Hospital Costa del Sol of 2015. In 2016 we perform formative lectures to the principal departments that refer patients to nephrology of phone “Nefroconsultor” that recommends referrals attending to KDIGO criteria. We studied referral of 2017 after intervention.

Results

628 patients with a mean age of 68 years-old, 63% were male, a mean creatinine at time of referral of 1,5mg/dL and a glomerular filtration rate of 46 ml/min/1,73m² (CKD-EPI). Comparing before and after intervention, previous implantation of phone app 333 patients were referred while after 295 patients were referred, a 10,1% less (p=0,001). There were no differences in age ( p=0,13); gender (p=0,197); serum creatinine (p=0,59) and glomerular filtration rate CKD-EPI (p=0,41). In 2015, 132 patients of 333 met stablished KDIGO criteria of referral (39,8%) while in 2017 200 patients of 295 (60,2%) and considered well referred (p=0,001). The increase of intervention success was of a 28,8% (binomial effect size display with Cohen`d effect size of 0,751). Previous the app 208 patients of 333 (63,2%) were referred with data of albuminuria while after 258 of 295 patients (89% p=0,001). The increase of intervention success was of a 25,7% (Cohen`d effect size of 0,744). Referral including urine sediment improved from a 69,3% to 87,2% (p=0,001) with an increase of intervention success of 12,2% (Cohen`d 0,28). Multivariate regression analysis using referral meeting KDIGO criteria as dependent variable and adjusting by age, sex and department of provenance, 2017 was associated with a correct referral with a odds ratio of 3,57 (IC 95%: 2,52-5,05) compared to 2015 (p=0,001). Proteinuria as the reason of referral to nephrology also increased from a 24% to a 34,8% (p=0,004).

Conclusion

The use of a tool as phone app (Nefroconsultor) improves the referral to nephrologist a 28,8% attending to referral stablished criteria. The app also increases the study of albuminuria and urine sediment at the moment of referral, increasing proteinuria as reason of referral.
UNDER REVIEW CJASN.