Referring patients with chronic kidney disease back to primary care: a criteria-based analysis in outpatient renal clinics

Author:

van Dipten Carola,van Dam Davy Gerda Hermina Antoin,de Grauw Wilhelmus Joannes Carolus,ten Dam Marcus Antonius Gerard Jan,Hermans Marcus Matheus Hendrik,Assendelft Willem Jan Jozef,Haan Nynke Dorothea Scherpbier-de,Wetzels Jacobus Franciscus Maria

Abstract

Abstract Background The increased demand for nephrology care for patients with chronic kidney disease (CKD) necessitates a critical review of the need for secondary care facilities and the possibilities for referral back to primary care. This study aimed to evaluate the characteristics and numbers of patients who could potentially be referred back to primary care, using predefined criteria developed by nephrologists and general practitioners. Method We organised a consensus meeting with eight nephrologists and two general practitioners to define the back referral (BR) criteria, and performed a retrospective cohort study reviewing records from patients under nephrologist care in three hospitals. Results We reached a consensus about the BR criteria. Overall, 78 of the 300 patients (26%) in the outpatient clinics met the BR criteria. The characteristics of the patients who met the BR criteria were: 56.4% male, a median age of 70, an average of 3.0 outpatients visits per year, and a mean estimated glomerular filtration rate of 46 ml/min/1,73m2. Hypertension was present in 67.9% of this group, while 27.3% had diabetes and 16.9% had cancer. The patients who could be referred back represented all CKD stages except stage G5. The most common stage (16%) was G3bA2 (eGFR 30 ≤ 44 and ACR 3 ≤ 30). Conclusion A substantial proportion of patients were eligible for referral back to primary care. These patients often have a comorbidity, such as hypertension or diabetes. Future research should focus on generalisability of the BR criteria, the feasibility of actual implementation of the back referral, follow-up assessments of renal function and patient satisfaction.

Publisher

Springer Science and Business Media LLC

Subject

Nephrology

Reference32 articles.

1. Hill NR, Fatoba ST, Oke JL, Hirst JA, O'Callaghan CA, Lasserson DS, et al. Global prevalence of chronic kidney disease - a systematic review and meta-analysis. PLoS One. 2016;11(7):e0158765. https://doi.org/10.1371/journal.pone.0158765.

2. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO. Clinical practice guideline for the evaluation and Management of Chronic Kidney Disease. Kidney Inter Suppl. 2012;2013(3):1–150.

3. Nederlands huisartsen genootschap. NHG - Standaard Chronische Nierschade. Huisarts en Wetenschap; 2018.

4. NICE Clinical guideline: Chronic kidney disease. Early identification and management of chronic kidney disease in adults in primary and secondary care. London: National Collaborating Centre And National Institute for Health and care Excellence; 2008 September (last modified 2014, July).

5. Smart NA, Titus TT. Outcomes of early versus late nephrology referral in chronic kidney disease: a systematic review. Am J Med. 2011;124(11):1073–80 e2. https://doi.org/10.1016/j.amjmed.2011.04.026.

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