title: Limited referral to nephrologists from a tertiary geriatric outpatient clinic despite a high prevalence of chronic kidney disease and anaemia.
abstract: BACKGROUND
  Chronic kidney disease (CKD) is increasing in prevalence world-wide with the largest growth being in the elderly. The aim of this study was to examine the prevalence of CKD in a geriatric outpatient clinic within a tertiary hospital and its association with anaemia and mortality with a focus on the referral patterns towards nephrologists.
  
  
  METHODS
  Retrospective study utilising administrative databases. The cohort was defined as all patients that attended the geriatric outpatient clinics of a single tertiary hospital within the first 3 months of 2006. Patients were followed for 18 months for mortality and referral to a nephrologist.
  
  
  RESULTS
  The mean Glomerular filtration rate (eGFR) of the 439 patients was 67.4 ± 29.1 mL/min/1.73 m² (44% <60 mL/min/1.73 m²). 11.8% had a haemoglobin < 110 g/L, with anaemia being significantly associated with kidney function in those with a eGFR < 60 mL/min/1.73 m² (p = 0.0092). Kidney function and anaemia were significantly associated with mortality on multivariate analysis (p = 0.019 and p = 0.0074). After 18 months, 8.8% of patients with CKD were referred to a nephrologist.
  
  
  CONCLUSIONS
  Despite a high prevalence of CKD in patients attending a geriatric outpatient clinic and its association with anaemia and mortality, few of these patients were referred to a nephrologist. An examination of the reasons behind this bias is required.
authors.affiliation: School of Medicine and Pharmacology, University of Western Australia, Verdun Street, Nedlands, WA, Australia. neil.boudville@uwa.edu.au
authors.forename: Neil
authors.initials: N
authors.lastname: Boudville
authors.forename: Kalindu
authors.initials: K
authors.lastname: Muthucumarana
authors.forename: Charles
authors.initials: C
authors.lastname: Inderjeeth
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data*; D000740:Anemia / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D060730:Glomerular Filtration Barrier; D006299:Health Services for the Aged / Q000706:statistics & numerical data*; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D008297:Male; D009398:Nephrology / Q000706:statistics & numerical data*; D015995:Prevalence; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology / Q000628:therapy*; D012189:Retrospective Studies; D062606:Tertiary Care Centers / Q000706:statistics & numerical data*; D014904:Western Australia / Q000453:epidemiology
chemical_list: D006454:Hemoglobins