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Kidney Week

Abstract: PO0512

Laboratory-Based Potential Indications vs. Risk-Based Triage for Nephrology Referrals in the Veterans Affairs Health System

Session Information

Category: CKD (Non-Dialysis)

  • 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

  • Duggal, Vishal, VA Palo Alto Health Care System, Palo Alto, California, United States
  • Montez-Rath, Maria E., Stanford University School of Medicine, Stanford, California, United States
  • Thomas, I-Chun, VA Palo Alto Geriatric Research Education and Clinical Center, Palo Alto, California, United States
  • Goldstein, Mary K., VA Palo Alto Health Care System, Palo Alto, California, United States
  • Kurella Tamura, Manjula, Stanford University School of Medicine, Stanford, California, United States
Background

Clinical decision support tools may facilitate identification of chronic kidney disease (CKD) and timely nephrology referral. Little is known about the potential effects they might have on the volume of nephrology referrals. We sought to estimate how the implementation of a CKD decision support tool could affect potential nephrology referral volume based on U.S. Veterans Affairs Health System (VA)/Department of Defense (DoD) guidelines, and the risk profile of referred patients.

Methods

In a retrospective cohort study of 434,735 patients with CKD, we determined the number of patients who met laboratory-based potential indications for nephrology referral based on VA/DoD guidelines. We used the Kidney Failure Risk Equation to estimate end-stage kidney disease (ESKD) risk and to determine how incorporating ESKD risk thresholds would modify referral volume.

Results

Among 70,972 patients meeting potential indications for referral who had not visited a nephrologist in 2013, 12,008 (16.9%) were referred in 2014. The two-year risk of ESKD was low in both groups, 2.9% [0.9-8.6%] in the referred group, compared to 1.3% [0.3-3.9%] in the unreferred group (P < 0.001). The number of patients meeting potential indications for referral was approximately equivalent to the number of patients with a two-year risk of ESKD exceeding 1%, or N=81,132. Among potential indications for referral, rapid eGFR decline accounted for 37.6% of eligible unreferred patients and was associated with the lowest two-year ESKD risk.

Conclusion

Laboratory-based potential indications for referral identify a large number of patients at low risk of ESKD. Further study is needed to determine the value of nephrology care for these populations.

Funding

  • Veterans Affairs Support