Rate of renal function decline, race and referral to nephrology in a large cohort of primary care patients.
Late nephrology referral is associated with adverse outcomes especially among minorities. Research on the association of the rate of chronic kidney disease (CKD) progression with nephrology referral in white versus black patients is lacking.



Compute the odds of nephrology referral in primary care and their associations with race and the rate of CKD progression.



Electronic health record data were obtained from 2170 patients in primary care clinics in the Saint Louis metropolitan area with at least two estimated glomerular filtration rate (eGFR) values over a 7-year observation period. Fast CKD progression was defined as a decline in eGFR of ≥5 ml/min/1.73 m2/year. Logistic regression models were computed to measure the associations between eGFR progression, race and nephrology referral before and after adjusting for potential confounding factors.



Nephrology referrals were significantly more prevalent among those with fast compared to slow progression (5.6 versus 2.0%, P < 0.0001), however, a majority of fast progressors were not referred. Fast CKD progression and black race were associated with increased odds of nephrology referral (OR = 2.74; 95% CI: 1.60-4.72 and OR = 2.42; 95% CI: 1.28-4.56, respectively). The interaction of race and eGFR progression in nephrology referral was found to be non-significant.



Nephrology referrals are more common in fast CKD progression, but referrals are underutilized. Nephrology referral is more common among blacks but its' association with rate of decline does not differ by race. Further studies are required to investigate the benefit of early referral of patients at risk of fast CKD progression.
Division of Nephrology, Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, MO, USA.|Renal Section, Department of Medicine, John Cochran VA medical Center, St. Louis, MO, USA.
Farrukh M
FM
Koraishy
Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, USA.
Denise
D
Hooks-Anderson
Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, USA.
Joanne
J
Salas
Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, USA.
Jeffrey F
JF
Scherrer
D000328:Adult; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D009398:Nephrology; D015995:Prevalence; D011320:Primary Health Care; D044469:Racial Groups; D012017:Referral and Consultation; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology* / Q000628:therapy; D012189:Retrospective Studies
CKD; GFR; progression; race; referral