title: Chronic kidney disease referral practices among non-nephrology specialists: A single-centre experience.
abstract: BACKGROUND
  Early referral of CKD patients to nephrology teams (NT) is vital to identify patients most likely to progress, delay decline of excretory function, and provide planned RRT. Unfortunately, many are still being referred late.
  
  
  METHODS
  We conducted a retrospective analysis to investigate referral rates, predictors of non-referral, and performed urine investigations in hospitalised CKD patients.
  
  
  RESULTS
  Out of 388 patients studied, 5.6%, 11.4%, and 16.4% in CKD3A, 3B, and 4+5, respectively, were referred to an NT upon discharge (CKD3A vs. CKD4+5, p=0.016). For every additional year of age, the odds of being referred decreased by 5% (OR: 0.95, CI: 0.92-0.98, p=0.003). Patients were more likely to be referred to an NT if they were males (OR: 2.31, CI: 1.09-4.90, p=0.029) and having reached CKD 4+5 (OR: 3.99, CI: 1.58-10.10, p=0.003). Only 28.8%, 43.9%, and 50.7% of patients with CKD3A, 3B, and 4+5 were followed up with urine investigations after discharge (p=0.001). CKD stage 3B (OR: 3.54, CI: 1.23-10.19, p=0.019), CKD stage 4+5 (OR: 6.06, CI: 1.69-21.67, p=0.006), DM (OR: 6.28, CI: 2.38-16.58, p<0.0001), and having been referred to a NT (OR: 20.95, CI: 3.54-123.92, p=0.001) were independent predictors for having urine investigations.
  
  
  CONCLUSIONS
  The highest rate of referral was achieved in males, younger age group, and those who have reached CKD stage 4+5. Urine tests remain largely underutilised and only a minority (16.4%) of patients with an eGFR <30mL/min/1.73m(2) were referred to a NT.
authors.affiliation: Nephrology Department, Mater Dei Hospital, Msida, Malta. Electronic address: jesmar_b@yahoo.co.uk.
authors.forename: Jesmar
authors.initials: J
authors.lastname: Buttigieg
authors.affiliation: Department of Medicine, Mater Dei Hospital, Msida, Malta. Electronic address: liam.mercieca@gov.mt.
authors.forename: Liam
authors.initials: L
authors.lastname: Mercieca
authors.affiliation: Department of Medicine, Mater Dei Hospital, Msida, Malta. Electronic address: ariellesaliba@gmail.com.
authors.forename: Arielle
authors.initials: A
authors.lastname: Saliba
authors.affiliation: Department of Medicine, Mater Dei Hospital, Msida, Malta. Electronic address: simon.b.aquilina@gov.mt.
authors.forename: Simon
authors.initials: S
authors.lastname: Aquilina
authors.affiliation: Nephrology Department, Mater Dei Hospital, Msida, Malta. Electronic address: emanuel.farrugia@gov.mt.
authors.forename: Emanuel
authors.initials: E
authors.lastname: Farrugia
authors.affiliation: Diabetes and Endocrine Department, Mater Dei Hospital, Msida, Malta. Electronic address: stephen.fava@um.edu.mt.
authors.forename: Stephen
authors.initials: S
authors.lastname: Fava
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000419:Albuminuria / Q000175:diagnosis; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate; D006760:Hospitalization; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009398:Nephrology; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology*; D012189:Retrospective Studies; D016482:Urinalysis
keywords: Albuminuria; Chronic kidney disease (CKD); Early referral/late referral; End stage kidney disease (ESKD); Urinalysis