Impact of Using Risk-Based Stratification on Referral of Patients With Chronic Kidney Disease From Primary Care to Specialist Care in the United Kingdom.
Introduction: The externally validated Kidney Failure Risk Equation (KFRE) for predicting risk of end-stage renal disease (ESRD) has been developed, but its potential impact in a population on referrals for patients with chronic kidney disease (CKD) from primary to specialty nephrology care is not known.
Methods: A cross-sectional population-based study of individuals in United Kingdom primary care registered in The Health Improvement Network database was conducted. National Institute of Health and Care Excellence (NICE) 2014 CKD guidelines versus the 4-variable KFRE set at a >3% risk of ESRD at 5 years were applied to patients identified with CKD stage 3-5 between January 1, 2016, and March 31, 2017.
Results: In all, 39,476 (36.6%) of 107,962 adults with CKD stage 3-5 had a urine albumin:creatinine ratio (ACR) available and entered into the primary analysis. Of that, 7566 (19.2%) patients fulfilled NICE criteria for referral, 2386 (31.5%) of whom had a </=3% 5-year risk of ESRD. Also 8663 (21.9%) patients had a >3% 5-year risk of ESRD, 3483 (40.2%) of whom did not fulfill NICE criteria; this represents 8.8% of the primary population. By using the KFRE threshold rather than NICE criteria for referral, 5869 patients (14.9% of the primary analysis population) would have been reallocated between primary and specialist care. Imputational analysis was used for missing ACR measurements and showed similar results.
Conclusions: A risk-based referral approach would lead to a substantial reallocation of patients between primary care and specialist nephrology care with only a small increase in numbers eligible, ensuring those at higher risk of progression are identified.
|投稿者||Bhachu, Harjeet K; Cockwell, Paul; Subramanian, Anuradhaa; Adderley, Nicola J; Gokhale, Krishna; Fenton, Anthony; Kyte, Derek; Nirantharakumar, Krishnarajah; Calvert, Melanie|
|ジャーナル名||Kidney international reports|
|組織名||Department of Renal Medicine, Queen Elizabeth Hospital Birmingham, Birmingham,;UK.;Institute of Applied Health Research, University of Birmingham, Birmingham, UK.;Centre for Patient Reported Outcomes Research (CPROR), Institute of Applied;Health Research, University of Birmingham, UK.;Institute of Immunity and Ageing, University of Birmingham, Birmingham, UK.;School of Allied Health and Community, University of Worcester, Worcester, UK.;Midlands Health Data Research UK, Birmingham, UK.;NIHR Birmingham Biomedical Research Centre, NIHR Surgical Reconstruction and;Microbiology Research Centre and NIHR ARC West Midlands, UK.|