Title : Outcomes of early versus late nephrology referrals in adults diagnosed with chronic kidney disease
Abstract:
PROBLEM: Chronic kidney disease (CKD) is an increasing health problem that results in a high economic burden to health systems and reduces quality of life. Patients with ESKD incur approximately 12 days of inpatient care per year and their annual death rates exceeds 150/1,000 patient years. Meta-analyses have shown that absent, infrequent, or late CKD nephrology care is associated with worse health outcomes, including substantially prolonged hospitalization and increase in mortality.
PURPOSE: The purpose of this study is to explore whether referring adults aged 18 years and older who have been diagnosed with CKD to a nephrologist earlier (eGFR of >30 ml/min) will slow their progression to ESKD.
EBP QUESTIONS: (1) Is there a relationship between participant characteristics, rate of ESKD progression, exercise, referral timing (eGFR <30 [late referral] and eGFR >30 [early referral]) for patients with CKD? (2) Is there a difference in the rate of ESKD progression between patient referred to a nephrologist early (eGFR >30ml/min) when compared to patients referred late (eGFR <30ml/min)?
METHODS: A retrospective chart review was used to select a convenience sample of patients managed within a nephrology practice.
OUTCOMES: The relationship between participant characteristics of race, rate of ESKD progression- blood pressure status, electrolyte abnormalities, bone mineral disease, anemia, and hemoglobin A1C when compared to referral timing the correlation was found to be statistically significant with the p-value < 0.05 level. Furthermore, the relationship between participant characteristics of gender and exercise, rate of ESKD progression- systolic blood pressure, diastolic blood pressure, and LDL cholesterol was not found to be statistically significant as their p-values were > 0.05 level. There is a statistically significant difference between the rate of ESKD progression- specifically in their blood pressure, electrolyte abnormalities, bone and mineral disease, anemia, and HgbA1C between patients who were referred to a nephrologist early (eGFR >30ml/min) when compared to patients referred late (eGFR <30ml/min) as the p-values were <0.05 as tested by the Chi-square test. There was not a statistically significant difference found between participant characteristics of gender and exercise, rate of ESKD progression- including systolic blood pressure, diastolic blood pressure, and LDL cholesterol as their p-values were > 0.05 level. Therefore, ESKD progression is slower for patients who are referred earlier to a nephrologist (eGFR of >30ml/min) compared to those referred later (eGFR or <30ml/min).
SIGNIFICANCE: There is a startling number of patients referred to the specialty of nephrology in stage IV and V CKD. Late referral usually means patients exhibit electrolyte abnormalities, refractory hypertension, anemia, and bone and mineral disease; negatively impacting health and well-being.
