The impact of estimated glomerular filtration rate reporting on nephrology referral pattern, patient characteristics and outcome.
BACKGROUND
Chronic kidney disease (CKD) is a growing public health problem worldwide. The estimated glomerular filtration rate (eGFR) has been advocated as a means to detect CKD. In January 2006, community laboratories in Ontario, Canada, began to report eGFR values along with every serum creatinine result. The present study sought to investigate the impact of eGFR reporting on nephrology referrals and patient outcome.


METHODS
We conducted a retrospective analysis of referrals to an adult general nephrology clinic 24 months before and after eGFR reporting took effect.


RESULTS
eGFR reporting was associated with a significant rise in the number of referrals (1,330-1,496, p = 0.009), a 33% rise in patient waiting time (from 75 to 100 days, p < 0.001), and an increase in nephrologists' workload. Patients referred after eGFR reporting were older, but suffered from fewer comorbidities such as hypertension and vascular disease. There was an increase in the number of patients referred with stage 3 CKD, but a drop in the proportion of stage 4 and 5 CKD referrals and no change in time to renal replacement therapy.


CONCLUSIONS
Laboratory reporting of eGFR increased nephrology referral volume, patient waiting times, and nephrologists' workload, without a demonstrable benefit in terms of detection and referral of severe (stage 4 and 5) CKD, nor in the reduction of end-stage renal disease frequency.
Department of Medicine, University of Toronto, Toronto, Ont., Canada. david.naimark@sunnybrook.ca
David M J
DM
Naimark
Ziv
Z
Harel
Rahim
R
Moineddin
Arik
A
Bergman
D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D003404:Creatinine / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009398:Nephrology / Q000706:statistics & numerical data; D009864:Ontario; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000503:physiopathology* / Q000628:therapy; D017582:Renal Replacement Therapy; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D013997:Time Factors; D014850:Waiting Lists; D016526:Workload
D003404:Creatinine