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Li K, Pirabhahar S, Thomsett M, Turner K, Wainstein M, Ha JT, Katz I. Use of kidney failure risk equation as a tool to evaluate referrals from primary care to specialist nephrology care. Intern Med J 2024. [PMID: 38532529 DOI: 10.1111/imj.16377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 01/04/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND With rising costs and burden of chronic kidney disease (CKD), timely referral of patients to a kidney specialist is crucial. Currently, Kidney Health Australia (KHA) uses a 'heat map' based on severity and not future risk of kidney failure, whereas the kidney failure risk equation (KFRE) score predicts future risk of progression. AIMS Evaluate whether a KFRE score assists with timing of CKD referrals. METHODS Retrospective cohort of 2137 adult patients, referred to tertiary hospital outpatient nephrologist between 2012 and 2020, were analysed. Referrals were analysed for concordance with the KHA referral guidelines and, with the KFRE score, a recommended practice. RESULTS Of 2137 patients, 626 (29%) did not have urine albumin-to-creatinine ratio (UACR) measurement at referral. For those who had a UACR, the number who met KFRE preferred referral criteria was 36% less than KHA criteria. If the recommended KFRE score was used, then fewer older patients (≥40 years) needed referral. Positively, many diabetes patients were referred, even if their risk of kidney failure was low, and 29% had a KFRE over 3%. For patients evaluated meeting KFRE criteria, a larger proportion (76%) remained in follow-up, with only 8% being discharged. CONCLUSIONS KFRE could reduce referrals and be a useful tool to assist timely referrals. Using KFRE for triage may allow those patients with very low risk of future kidney failure not be referred, remaining longer in primary care, saving health resources and reducing patients' stress and wait times. Using KFRE encourages albuminuria measurement.
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Affiliation(s)
- Katherine Li
- Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Saiyini Pirabhahar
- Department of Renal Medicine, St George Hospital, Sydney, New South Wales, Australia
| | - Max Thomsett
- Department of Renal Medicine, St George Hospital, Sydney, New South Wales, Australia
| | - Kylie Turner
- Department of Renal Medicine, St George Hospital, Sydney, New South Wales, Australia
| | - Marina Wainstein
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Jeff T Ha
- Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
- The George Institute for Global Health, Sydney, New South Wales, Australia
| | - Ivor Katz
- Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
- Department of Renal Medicine, St George Hospital, Sydney, New South Wales, Australia
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2
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Frías A, Vargas F, Sandino J, Berzal R, Rivero M, Cordero L, Cavero T, Segura J, García F, Hernández E, Gutiérrez E, Auñón P, Zamanillo I, Pascual J, Morales E. Octogenarians with chronic kidney disease in the nephrology clinic: Progressors vs. non-progressors. FRONTIERS IN NEPHROLOGY 2023; 3:1114486. [PMID: 37675351 PMCID: PMC10479568 DOI: 10.3389/fneph.2023.1114486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 01/18/2023] [Indexed: 09/08/2023]
Abstract
Background The current definition of chronic kidney disease applied to patients over the age of 80 has increased the number of referrals to Nephrology. However not all of these patients may benefit from its assessment. This study aims to analyze the evolution of ≥80 years old patients referred to Nephrology. Methods Single-center study including patients ≥80 years old with eGFR <60 mL/min/1,73m2 who were referred to Nephrology consultation for the first time. Clinical and analytical parameters were collected retrospectively 12 months before the visit, and prospectively at baseline, and 12 and 24 months after the initial visit. We divided patients into two groups based on annual eGFR loss: progressors (>5 mL/min/1.73m2) and non-progressors (≤5 mL/min/1,73m2). Results A total of 318 patients were included, mean age was 84,9 ± 4 (80-97) years. Baseline serum creatinine was 1,65 ± 0,62 mg/dL, eGRF 35 (28-42) mL/min/1,73, and albumin/creatinine ratio 36 (7-229) mg/g. 55,7% of the patients met the definition of progressor at baseline (initial-progressors), 26,3% were progressors after a 12-month follow-up and 13,4% after 24 months. 21,2% and 11,4% of initial-progressors met this definition at 12 and 24 month follow up. The main risk factor for progression was albuminuria. No relationship was found between the nephrologist intervention and the evolution of renal function among initial non-progressors. Conclusion Elderly patients who have stable renal function at the time of referral will continue to have stable renal function over the subsequent 24 months and thus may not need to be referred to a nephrologist.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Enrique Morales
- Department of Nephrology, Hospital 12 de Octubre, Madrid, Spain
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3
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Poyah PS, Quraishi TA. The Impact of a New Triage and Booking System on Renal Clinic Wait Times. Can J Kidney Health Dis 2020; 7:2054358120924140. [PMID: 32547773 PMCID: PMC7271271 DOI: 10.1177/2054358120924140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 03/17/2020] [Indexed: 11/23/2022] Open
Abstract
Background: Prolonged wait times are known barriers to accessing nephrology care for
patients needing more urgent specialist services. Improved process and
standardized triage systems are known to minimize wait times of urgent or
semi-urgent care in health care disciplines. In Central Zone (CZ) renal
clinic, mean wait times for urgent (P1) and semi-urgent (P2) referrals were
prolonged before 2014. We also observed prolonged wait times for elective
(P3-P5) categories. Improving wait times was identified as an access to care
quality improvement focus in CZ renal clinic of the Nova Scotia Health
Authority (NSHA). Objectives: To describe our new referral process and new triage system, and to examine
their effect on number of referrals wait-listed and mean wait times. Design: A quasi-experimental design was used. Setting: Halifax, Nova Scotia, Canada. Participants: Patients referred to Central Zone Renal Clinic between 2012 and 2018. Measurements: A time series of referral counts and wait times for each triage category were
measured before our interventions and after implementing our
interventions. Methods: We reviewed our referral processes to identify gaps leading to prolonged wait
times. On January 1, 2014, we implemented new administrative procedures:
pretriage (standardized referral information form and staff training),
triage (standardized clinic intake criteria and new triage guidelines),
posttriage (protecting clinic spots for urgent and semi-urgent referrals,
wait-list maintenance, and increasing new referral clinic capacity). Data
were collected prospectively. Descriptive analysis on mean wait times was
done using run charts. Results: A 33% reduction in total number of referrals wait-listed was observed over
4.5 years after intervention. Descriptive analysis of the urgent and
semi-urgent categories (P1 and P2) revealed a significant shift of mean wait
times on run charts after the interventions. Target wait time was achieved
in 94% of P1 category and 78% of P2 category. Limitations: This type of study design does not exclude confounding variables influencing
results. We did not explore stakeholder satisfaction or whether the new
referral process presented barriers to resending referrals that had
insufficient triage data. The long-term sustainability of adding
demand-responsive surge clinics and opportunity cost were not assessed. Our
referral process and triage system have not been externally validated and
may not be applicable in settings without wait-lists or settings that use
electronic, telephone or telemedicine consults. Conclusion: Our selective intake of referrals with adequate triage information and
referrals needing nephrology consult as defined by our clinic intake
criteria reduced number of referrals wait-listed. We saw improved wait times
for urgent and semi-urgent referrals with these categories now falling
within target wait times for the vast majority of patients. The work of this
improvement initiative continues especially for the lower-risk triage
categories. Trial registration: Not applicable as this was a Quality improvement initiative.
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4
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Brimble KS, Boll P, Grill AK, Molnar A, Nash DM, Garg A, Akbari A, Blake PG, Perkins D. Impact of the KidneyWise toolkit on chronic kidney disease referral practices in Ontario primary care: a prospective evaluation. BMJ Open 2020; 10:e032838. [PMID: 32066603 PMCID: PMC7044871 DOI: 10.1136/bmjopen-2019-032838] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES Chronic kidney disease (CKD) is common; therefore, coordination of care between primary care and nephrology is important. Ontario Renal Network's KidneyWise toolkit was developed to provide guidance on the detection and management of people with CKD in primary care (www.kidneywise.ca). The aim of this study was to evaluate the impact of the April 2015 KidneyWise toolkit release on the characteristics of primary care referrals to nephrology. DESIGN AND SETTING The study was a prospective pre-post design conducted at two nephrology sites (community site: Trillium Health Partners in Mississauga, Ontario, Canada, and academic site: St Joseph's Healthcare in Hamilton, Ontario, Canada). Referrals were compared during the 3-month time period immediately prior to, and during a 3-month period 1 year after, the toolkit release. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was the change in proportion of referrals for CKD that met the KidneyWise criteria. Additional secondary referral and quality of care outcomes were also evaluated. Multivariable logistic regression was used to evaluate preselected variables for their independent association with referrals that met the KidneyWise criteria. RESULTS The proportion of referrals for CKD among people who met the KidneyWise referral criteria did not significantly change from pre-KidneyWise to post-KidneyWise implementation (44.7% vs 45.8%, respectively, adjusted OR 1.16, 95% CI 0.85 to 1.59, p=0.36). The proportion of referrals for CKD that provided a urine albumin-creatinine ratio significantly increased post-KidneyWise (25.8% vs 43.8%, adjusted OR 1.45, 95% CI 1.06 to 1.97, p=0.02). The significant independent predictors of meeting the KidneyWise referral criteria were academic site, increased age and use of the KidneyWise referral form. CONCLUSIONS We did not observe any change in the proportion of appropriate referrals for CKD at two large nephrology centres 1 year after implementation of the KidneyWise toolkit.
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Affiliation(s)
| | - Philip Boll
- Nephrology, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Allan K Grill
- Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Amber Molnar
- Medicine, McMaster University, Hamilton, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Danielle M Nash
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Amit Garg
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Medicine, University of Western Ontario, London, Ontario, Canada
| | - Ayub Akbari
- Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Peter G Blake
- Medicine, University of Western Ontario, London, Ontario, Canada
| | - David Perkins
- Nephrology, Trillium Health Partners, Mississauga, Ontario, Canada
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5
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Chen JH, Chiu YW, Hwang SJ, Tsai JC, Shi HY, Lin MY. Effect of nephrology referrals and multidisciplinary care programs on renal replacement and medical costs on patients with advanced chronic kidney disease: A retrospective cohort study. Medicine (Baltimore) 2019; 98:e16808. [PMID: 31415394 PMCID: PMC6831162 DOI: 10.1097/md.0000000000016808] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Evidence-based studies have revealed outcomes in patients with chronic kidney disease that differed depending on the design of care delivery. This study compared the effects of 3 types of nephrology care: multidisciplinary care (MDC), nephrology care, and non-nephrology care. We studied their effects on the risks of requiring dialysis and the differences between these methods had on long-term medical resource utilization and costs.We conducted a retrospective cohort study involving patients with an estimated glomerular filtration rate of (eGFR) ≤45 mL/min/1.73 m from 2005 to 2007. Patients were divided into MDC, non-MDC, and non-nephrology referral groups. Between-group differences with regard to the risk of requiring dialysis and annual medical utilization and costs were evaluated using a 5-year follow-up period.In total, 661 patients were included. After other covariates and the competing risk of death were taken into account, we observed a significant (56%) reduction in the incidence of dialysis in both the MDC and non-MDC groups relative to the non-nephrology referral group. Costs were markedly lower in the MDC group relative to the other groups (average savings: US$ 830 per year; 95% confidence interval: 367-1295; P < .001).For patients without nephrology referrals, MDC can substantially reduce their risk of developing end-stage renal disease and lower their medical costs. We therefore strongly advocate that all patients with an eGFR of ≤45 mL/min/1.73 m should be referred to a nephrologist and receive MDC.
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Affiliation(s)
- Jui-Hsin Chen
- Department of Nursing, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University Hospital
- Department of Healthcare Administration and Medical Informatics, College of Health Sciences
| | - Yi-Wen Chiu
- Department of Internal Medicine, Division of Nephrology, Kaohsiung Medical University Hospital
- Department of Renal Care, College of Medicine
| | - Shang-Jyh Hwang
- Department of Internal Medicine, Division of Nephrology, Kaohsiung Medical University Hospital
- Department of Renal Care, College of Medicine
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung
- Institute of Population Sciences, National Health Research Institutes, Miaoli
| | - Jer-Chia Tsai
- Department of Internal Medicine, Division of Nephrology, Kaohsiung Medical University Hospital
- Department of Renal Care, College of Medicine
| | - Hon-Yi Shi
- Department of Healthcare Administration and Medical Informatics, College of Health Sciences
| | - Ming-Yen Lin
- Department of Internal Medicine, Division of Nephrology, Kaohsiung Medical University Hospital
- Department of Renal Care, College of Medicine
- Master of Public Health Degree Program, College of Public Health, National Taiwan University, Taipei, Taiwan
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6
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Ludlow M, Jesudason S, Johnson DW. Automatic reporting of estimated glomerular filtration rate in Australia turns 13: re-examining the impact. Med J Aust 2019; 209:244-245. [PMID: 30208814 DOI: 10.5694/mja18.00544] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 07/03/2018] [Indexed: 11/17/2022]
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7
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Wan Zukiman WZH, Yaakup H, Zakaria NF, Shah SAB. Symptom Prevalence and the Negative Emotional States in End-Stage Renal Disease Patients with or without Renal Replacement Therapy: A Cross-Sectional Analysis. J Palliat Med 2017; 20:1127-1134. [PMID: 28537462 DOI: 10.1089/jpm.2016.0450] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Limited comparative data are available on the symptom severity and burden of dialyzed versus nondialyzed end-stage renal disease (ESRD) patients and their association with negative emotional states. OBJECTIVE To investigate the prevalence of symptom burden and severity of ESRD patients and correlate the findings with their psychological status. METHODS This was a cross-sectional study of dialyzed (N = 87) and nondialyzed (N = 100) patients. The symptom burden and severity were determined using the Dialysis Symptom Index (DSI) and the psychological assessment using Depression Anxiety Stress Scale 21 (DASS-21). RESULTS Symptom severity evaluated using the DSI was comparable in both groups with fatigue as the most common symptom (n = 141, 75.4%), followed by sleep-related, sexual dysfunction, and dry skin problems. The symptom burden for worrying, dry skin and mouth, decreased appetite, numbness, and leg swelling were significant in not dialyzed group (p < 0.05).The DASS-21 scores revealed that 11% of patients were depressed, 21.8% were stressed, and 15.6% were anxious (p < 0.030). The prevalence of psychological disturbances was associated with high symptom burden regardless of their treatment options (p < 0.005). Dialyzed patients showed a positive psychological status trend on DASS-21 assessment. The not dialyzed group consisted of 34% from comprehensive conservative group, 26% of choice-restricted conservative care, and 40% with no definitive future plan. CONCLUSIONS There was no difference in the prevalence of symptom burden and severity, irrespective of the type of treatment. Psychological disturbances were associated with higher symptom burden and severity and, therefore, should be screened thoroughly to achieve optimal ESRD management.
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Affiliation(s)
| | - Hayati Yaakup
- 1 Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre , Kuala Lumpur, Malaysia
| | - Nor Fadhlina Zakaria
- 2 Department of Medicine, Medical and Health Science Faculty, University Putra Malaysia , Selangor, Malaysia
| | - Shamsul Azhar Bin Shah
- 3 Department of Community Medicine, Universiti Kebangsaan Malaysia Medical Centre, UKM Medical Molecular Biology Institute (UMBI) , Kuala Lumpur, Malaysia
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8
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McClure M, Jorna T, Wilkinson L, Taylor J. Elderly patients with chronic kidney disease: do they really need referral to the nephrology clinic? Clin Kidney J 2017; 10:698-702. [PMID: 28979782 PMCID: PMC5622896 DOI: 10.1093/ckj/sfx034] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 03/27/2017] [Indexed: 11/27/2022] Open
Abstract
Introduction Chronic kidney disease (CKD) is becoming increasingly common, especially in the elderly. In the UK, there has been a marked increase in the awareness and detection of CKD over the last decade. This is largely attributable to the introduction of automated estimated glomerular filtration rate (eGFR) reporting and renal indicators in the primary care Quality and Outcomes Framework (QOF) initiative, both of which were introduced in 2006. These two initiatives have had a significant impact on referral patterns to renal services. Across the UK there has been a sustained increase in patients referred to nephrology clinics. The increased referrals have led to an older patient cohort, for whom specialist nephrology input is of questionable clinical benefit. This study aims to assess the outcomes of such patients referred to nephrology clinics in Dorset. Methods Retrospective data were collected on all new referrals to the nephrology outpatient clinic at Dorset County Hospital between April 2006 and March 2007. We specifically examined all patients >80 years of age who had CKD Stage 4 or 5. Outcomes of interest included the rate of decline in eGFR, renal-specific management implemented by the clinic, need for renal replacement therapy and death. These outcomes were used to compare the difference between those patients kept under regular follow-up in the nephrology clinic and those discharged back to primary care. Patients were followed up until March 2014. Results In all, 124 patients who were ≥80 years of age had CKD Stage 4 (115 patients) or 5 (9 patients). The mean age was 84.4 (range 80–95) years. In all, 66 patients were kept under regular follow-up in the clinic and 58 patients were discharged back to primary care. Patients kept under follow-up tended to have a lower median eGFR at referral (22 mL/min/1.73 m2 versus 26 mL/min/1.73 m2; P = 0.051) and had a significantly more rapid decline in mean eGFR over the next 7 years (1.58 mL/min/1.73 m2/yr versus 0.357 ml/min/1.73 m2/yr; P = 0.023) compared with those discharged back to primary care. More patients were commenced on erythropoietin (12 versus 3; P = 0.03) and more patients were commenced on dialysis (5 versus 0; P = 0.03) in the follow-up group compared with those discharged back to primary care. No patients from either group underwent a kidney biopsy. In those patients followed up, 55 (83%) died, with a median time to death of 2.66 years [interquartile range (IQR) 1.14–4.97]. Of the patients discharged, 45 (78%) died, with a median time to death of 3.57 years (IQR 2.31–5.68). Conclusions This study highlights the uncertain clinical benefit gained from referral to the nephrology clinic for the majority of elderly patients and suggests that for many cases their care could be safely and appropriately managed in the primary care setting. With the increasing prevalence of CKD in the elderly and increasing pressure on new patient clinic slots, referral of a select group in which a specific intervention is being considered may be more appropriate.
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Affiliation(s)
- Mark McClure
- Dorset County Hospital NHS Foundation Trust, Dorset, UK
| | - Thomas Jorna
- Dorset County Hospital NHS Foundation Trust, Dorset, UK
| | | | - Joanne Taylor
- Dorset County Hospital NHS Foundation Trust, Dorset, UK
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9
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Wetmore JB, Liu J, Li S, Hu Y, Peng Y, Gilbertson DT, Collins AJ. The Healthy People 2020 Objectives for Kidney Disease: How Far Have We Come, and Where Do We Need to Go? Clin J Am Soc Nephrol 2017; 12:200-209. [PMID: 27577245 PMCID: PMC5220656 DOI: 10.2215/cjn.04210416] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The Healthy People 2020 initiative established goals for patients with CKD and ESRD. We assessed United States progress toward some of these key goals. Using data from the Centers for Medicare and Medicaid Services ESRD database, we created yearly cohorts of patients on incident and prevalent dialysis from 2000 to 2013. Change in event rate or proportion change over the study years was modeled using Poisson regression with adjustment for age, race, sex, and primary cause of ESRD. For all-cause mortality in prevalent patients, Healthy People 2020 sought approximately 0.8% relative annual improvement; actual improvement was 2.7%. Improvement was greatest for patients ages 18-44 years old (3.8%; P<0.01 versus 2.8% for ages 65-74 years old) and 2.3% even for patients ages ≥75 years old. For mortality in incident patients, the relative annual decrease was 2.1% overall, a twofold improvement over the goal; mortality decreased nearly twice as much in black as in white patients (3.2% versus 1.8%; P<0.001). Geographic variation was substantial; the relative annual decrease was 0.6% in the Midwest and more than fourfold greater (2.7%) in the South. Cardiovascular mortality in prevalent patients decreased dramatically at 5.0% per year, far exceeding the annual goal of approximately 0.8%; the decrease was greatest in patients ages ≥75 years old (5.5%; P<0.001 versus ages 65-74 years old; 5.1%). The relative annual increase in percentages of patients with a fistula at dialysis initiation was 2.4%, roughly three times the goal; the increase was greater for black than white patients (3.2% versus 2.3%; P<0.01). Adjusted regional differences varied greater than twofold: 2.0% for the South versus 4.1% for the Midwest. Thus, although gains have been substantial, not all groups have benefitted equally. Goal development for Healthy People 2030 should consider changes in goal paradigms, such as tailoring by geographic region and incorporating patient-centered goals.
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Affiliation(s)
- James B. Wetmore
- Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, Minnesota
- Division of Nephrology, Hennepin County Medical Center, Minneapolis, Minnesota; and
| | - Jiannong Liu
- Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, Minnesota
| | - Suying Li
- Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, Minnesota
| | - Yan Hu
- Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, Minnesota
| | - Yi Peng
- Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, Minnesota
| | - David T. Gilbertson
- Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, Minnesota
| | - Allan J. Collins
- Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, Minnesota
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota
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10
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Gasparini A, Evans M, Coresh J, Grams ME, Norin O, Qureshi AR, Runesson B, Barany P, Ärnlöv J, Jernberg T, Wettermark B, Elinder CG, Carrero JJ. Prevalence and recognition of chronic kidney disease in Stockholm healthcare. Nephrol Dial Transplant 2016; 31:2086-2094. [PMID: 27738231 DOI: 10.1093/ndt/gfw354] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 08/26/2016] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is common, but the frequency of albuminuria testing and referral to nephrology care has been difficult to measure. We here characterize CKD prevalence and recognition in a complete healthcare utilization cohort of the Stockholm region, in Sweden. METHODS We included all adult individuals (n = 1 128 058) with at least one outpatient measurement of IDMS-calibrated serum creatinine during 2006-11. Estimated glomerular filtration rate (eGFR) was calculated via the CKD-EPI equation and CKD was solely defined as eGFR <60 mL/min/1.73 m2. We also assessed the performance of diagnostic testing (albuminuria), nephrology consultations, and utilization of ICD-10 diagnoses. RESULTS A total of 68 894 individuals had CKD, with a crude CKD prevalence of 6.11% [95% confidence interval (CI): 6.07-6.16%] and a prevalence standardized to the European population of 5.38% (5.33-5.42%). CKD was more prevalent among the elderly (28% prevalence >75 years old), women (6.85 versus 5.24% in men), and individuals with diabetes (17%), hypertension (17%) or cardiovascular disease (31%). The frequency of albuminuria monitoring was low, with 38% of diabetics and 27% of CKD individuals undergoing albuminuria testing over 2 years. Twenty-three per cent of the 16 383 individuals satisfying selected KDIGO criteria for nephrology referral visited a nephrologist. Twelve per cent of CKD patients carried an ICD-10 diagnostic code of CKD. CONCLUSIONS An estimated 6% of the adult Stockholm population accessing healthcare has CKD, but the frequency of albuminuria testing, nephrology consultations and registration of CKD diagnoses was suboptimal despite universal care. Improving provider awareness and treatment of CKD could have a significant public health impact.
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Affiliation(s)
- Alessandro Gasparini
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Technology and Intervention, Karolinska Institutet, Stockholm, Sweden
| | - Marie Evans
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Technology and Intervention, Karolinska Institutet, Stockholm, Sweden
| | - Josef Coresh
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
| | - Morgan E Grams
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD, USA.,Division of Nephrology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Olof Norin
- Medical Management Center, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Abdul R Qureshi
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Technology and Intervention, Karolinska Institutet, Stockholm, Sweden
| | - Björn Runesson
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Technology and Intervention, Karolinska Institutet, Stockholm, Sweden
| | - Peter Barany
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Technology and Intervention, Karolinska Institutet, Stockholm, Sweden
| | - Johan Ärnlöv
- School of Health and Social Studies, Dalarna University, Falun, Sweden.,Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden
| | - Tomas Jernberg
- Deptartment of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Björn Wettermark
- Public Healthcare Services committee, Stockholm County Council, Stockholm, Sweden.,Center for Pharmacoepidemiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Carl G Elinder
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Technology and Intervention, Karolinska Institutet, Stockholm, Sweden.,Public Healthcare Services committee, Stockholm County Council, Stockholm, Sweden
| | - Juan-Jesüs Carrero
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Technology and Intervention, Karolinska Institutet, Stockholm, Sweden.,Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
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