Chronic kidney disease referral practices among non-nephrology specialists : a single-centre experience

Abstract

Background: Early referral of CKD patients to nephrology teams (NT) is vital to identify patients most likely to progress, delay decline of excretory function, and provide planned RRT. Unfortunately, many are still being referred late. Methods: We conducted a retrospective analysis to investigate referral rates, predictors of non-referral, and performed urine investigations in hospitalised CKD patients. Results: Out of 388 patients studied, 5.6%, 11.4%, and 16.4% in CKD3A, 3B, and 4 + 5, respectively, were referred to an NT upon discharge (CKD3A vs. CKD4 + 5, p = 0.016). For every additional year of age, the odds of being referred decreased by 5% (OR: 0.95, CI: 0.92-0.98, p = 0.003). Patients were more likely to be referred to an NT if they were males (OR: 2.31, CI: 1.09-4.90, p = 0.029) and having reached CKD 4 + 5 (OR: 3.99, CI: 1.58-10.10, p = 0.003). Only 28.8%, 43.9%, and 50.7% of patients with CKD3A, 3B, and 4 + 5 were followed up with urine investigations after discharge (p = 0.001). CKD stage 3B (OR: 3.54, CI: 1.23-10.19, p = 0.019), CKD stage 4 + 5 (OR: 6.06, CI: 1.69-21.67, p = 0.006), DM (OR: 6.28, CI: 2.38-16.58, p < 0.0001), and having been referred to a NT (OR: 20.95, CI: 3.54-123.92, p = 0.001) were independent predictors for having urine investigations. Conclusion: The highest rate of referral was achieved in males, younger age group, and those who have reached CKD stage 4 + 5. Urine tests remain largely underutilised and only a minority (16.4%) of patients with an EGFR < 30 mL/min/1.73 m2 were referred to a NT.