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Kidney Week

Abstract: PO2308

Trends in Volume, Appropriateness, and Outcomes of Referrals to Nephrology over the Last Two Decades: A Retrospective Analysis Using the Alberta Kidney Disease Network Database

Session Information

Category: CKD (Non-Dialysis)

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

Authors

  • Ghimire, Anukul, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
  • Ye, Feng, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
  • Hemmelgarn, Brenda, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
  • Zaidi, Deenaz, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
  • Jindal, Kailash K., University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
  • Khan, Maryam, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
  • Tinwala, Mohammed M., University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
  • Sultana, Naima, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
  • Ronksley, Paul E., University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
  • Muneer, Shezel, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
  • Klarenbach, Scott, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
  • Okpechi, Ikechi G., University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
  • Bello, Aminu K., University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
Background

It is well-established that guideline-concordant referrals to nephrology are associated with improved patient outcomes. However, some referrals are unnecessary (guideline-discordant) leading to high volumes and delays for referrals that are guideline concordant. We investigated the trends in the number of referrals to nephrology, and related outcomes in Alberta.

Methods

Retrospective cohort analysis of patients with at least one visit to a nephrologist from primary care between 2006 and 2019. A referral was considered appropriate based on the KDIGO defined criteria (estimated glomerular filtration rate (eGFR) < 30 mL/min per 1.73m2, albumin creatinine ratio (ACR) ≥ 30 mg/mmol or protein creatinine ratio ≥ 50 mg/mmol, or Urine dipstick ≥ 2+ protein on two consecutive measurements, and/or eGFR persistently declined ≥ 5 mL/min per 1.73m2 from the first eGFR measurement).

Results

Of 69,372 patients (mean age 62.5; 50.7% female), only 28,518 (41.1%) referrals met criteria as guideline-concordant (Figure 1A). Patients referred in a guideline-concordant manner were significantly more likely to be older, men, and with comorbid conditions (diabetes, hypertension, and cardiovascular disease). There has been an increasing trend in the number of guideline concordant and discordant referrals from 2006 to 2019 (Figure 1B). Patients who met guideline-criteria for referrals were likely to be prescribed renoprotective medications but more likely to experience clinical outcomes of kidney failure, cardiovascular events, and all-cause mortality.

Conclusion

The number of referrals to nephrology from primary care continues to increase, and a large proportion of these referrals were guideline discordant. Interventions targeted to primary care at reducing the number of non-guideline concordant referrals are needed.