[en] INTRODUCTION: Chronic kidney disease (CKD) affects > 10% of the population but not all CKD patients require referral to a nephrologist. Various recommendations for referral to nephrologists are proposed worldwide. We examined the profile of French patients consulting a nephrologist for the first time and compared these characteristics with the recommendations of the International Kidney Disease: Improving Global Outcomes (KDIGO), the French "Haute Autorité de Santé" (HAS), and the Canadian Kidney Failure Risk Equation (KFRE).
METHODS: University Hospital electronic medical records were used to study patients referred for consultation with a nephrologist for the first time from 2016 to 2018. Patient characteristics (age, sex, diabetic status, estimated glomerular filtration rate (eGFR) and urine protein-to-creatinine ratio (PCR), etiology reported by the nephrologist) and 1-year patient follow-up were analyzed and compared with the KDIGO, HAS and Canadian-KFRE recommendations for referral to a nephrologist. The stages were defined according to the KDIGO classification, based upon kidney function and proteinuria. RESULTS: The 1,547 included patients had a median age of 71 [61-79] years with 56% males and 37% with diabetes. The main nephropathies were vascular (40%) and glomerular (20%). The KDIGO classification revealed 30%, 47%, 19%, 4% stages G1-2 to G5, and 50%, 22%, 28% stages A1-A3, respectively. According to KDIGO, HAS and KFRE scores, nephrologist referral was indicated for 42%, 57% and 80% of patients respectively, with poor agreement between recommendations. Furthermore, we observed 890 (57%) patients with an eGFR> 30 ml/min and a urine protein to creatinine ratio 0.5 g/g, mostly aged over 65 years (67%); 40% were diabetic, and 57% had a eGFR > 45 ml/min/1.73m2, 56% were diagnosed as vascular nephropathy and 11% with unknown nephropathy.
CONCLUSION: These results underline the importance of better identifying patients for referral to a nephrologist and informing general practitioners. Other referral criteria (age and etiology of the nephropathy) are debatable.
Disciplines :
Urology & nephrology
Author, co-author :
Schulz, Céline; Service de Nephrologie, Dialyses Apherese, Hopital Universitaire de Nimes, Nimes, France
Messikh, Ziyad; Service de Nephrologie, Dialyses Apherese, Hopital Universitaire de Nimes, Nimes, France
Reboul, Pascal; Service de Nephrologie, Dialyses Apherese, Hopital Universitaire de Nimes, Nimes, France
Cariou, Sylvain; Service de Nephrologie, Dialyses Apherese, Hopital Universitaire de Nimes, Nimes, France
Ahmadpoor, Pedram; Service de Nephrologie, Dialyses Apherese, Hopital Universitaire de Nimes, Nimes, France
Pambrun, Emilie; Service de Nephrologie, Dialyses Apherese, Hopital Universitaire de Nimes, Nimes, France
Prelipcean, Camelia; Service de Nephrologie, Dialyses Apherese, Hopital Universitaire de Nimes, Nimes, France
Garo, Florian; Service de Nephrologie, Dialyses Apherese, Hopital Universitaire de Nimes, Nimes, France
Prouvot, Julien; Service de Nephrologie, Dialyses Apherese, Hopital Universitaire de Nimes, Nimes, France ; IDESP, INSERM Montpellier, Montpellier, France
DELANAYE, Pierre ; Centre Hospitalier Universitaire de Liège - CHU > > Service de néphrologie ; Service de Nephrologie, Dialyses Apherese, Hopital Universitaire de Nimes, Nimes, France
Moranne, Olivier ; Service de Nephrologie, Dialyses Apherese, Hopital Universitaire de Nimes, Nimes, France. olivier.moranne@chu-nimes.fr ; IDESP, INSERM Montpellier, Montpellier, France. olivier.moranne@chu-nimes.fr
Language :
English
Title :
Characteristics of outpatients referred for a first consultation with a nephrologist: impact of different guidelines.
Publication date :
14 January 2022
Journal title :
Journal of Nephrology
ISSN :
1121-8428
eISSN :
1724-6059
Publisher :
Springer Science and Business Media Deutschland GmbH, Italy
The authors wish to thank Nîmes University Hospital, France, for its structural, human, and financial support through the award obtained by our team during the internal call for tenders “Thématiques émergentes” (emerging themes). We also thank Teresa Sawyers, medical writer at the BESPIM, Nîmes University Hospital, France, for her expertise in reviewing and editing this paper.
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