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02-04-2012 | General practice | Article

Automatic eGFR reporting may increase inappropriate CKD referrals

Abstract

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MedWire News: Automatic laboratory reporting of patient estimated glomerular filtration rate (eGFR) results increases the number of chronic kidney disease (CKD) referrals made to nephrologists, Canadian study results indicate.

However, use of this strategy increases both inappropriate and appropriate CKD referral rates, the authors report.

"Increases in the number of inappropriate referrals will increase wait times for nephrology consultations, delaying care for patients who need urgent attention, and will increase costs to the health care system," explain Ayub Akbari (The Ottawa Hospital, Ontario) and co-authors.

They highlight that automatic eGFR reporting systems may therefore need further refining to ensure that all nephrology referrals arising from eGFR results are truly indicated.

The study involved the analysis of CKD referral rates to nephrologists at The Ottawa Hospital in the year preceding and the year following the introduction of automatic eGFR reporting in Ontario-based hospitals.

A total of 2672 patients were included in the analysis. Of these, 1207 were referred before eGFR reporting measures were introduced, and 1465 after.

Patients aged over 80 years and women were two groups that exhibited a particularly marked increase in referral rates before and after the introduction of eGFR reporting. Specifically, referrals for the former group increased from 17.5% before to 25.5% after eGFR reporting, and the latter group experienced a referral rate increase from 41.7% before to 54.3% after the introduction of eGFR reporting.

As reported in the Canadian Medical Association Journal, when a time-series analysis was performed, a relative increase of 80.6% was observed in the total number of CKD referrals made after the introduction of automatic eGFR reporting compared with before.

Appropriate and inappropriate referrals, rose by 43.2% and 36.8%, respectively.

Of note, referrals were deemed appropriate if an eGFR of less than 30 ml/min/1.73 m2, progressive eGFR decline of greater than 20% per year, protein excretion greater than 1 g/24-hour collection of urine, urine protein-to-creatinine ratio greater than 100 mg/mmol, or a urine albumin-to-creatinine ratio of greater than 60 mg/mmol was present.

Akbari and colleagues say that the rise in inappropriate referrals may reflect a lack of knowledge or consensus about what defines an appropriate referral, or a lack of resources for the adequate management of patients with mild kidney disease in a primary care setting.

"Future research should be directed to understanding the reasons for inappropriate referral and to develop novel interventions for improving the referral process," conclude Akbari et al.

By Lauretta Ihonor

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