Late referral for dialysis: improving the management of chronic renal disease

Roderick, Paul; Jones, Chris; Tomson, Charles; Mason, Juan C.

doi:10.1093/qjmed/95.6.363

Cited by 56 publications

(46 citation statements)

References 20 publications

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“…in the 4 months prior to the start of renal replacement therapy) would result in a worse outcome in terms of complications and survival, as well as in a significant increase in the costs involved in the management of patients with CKD. [40][41][42][43][44][45] In the past, various guidelines recommended that the nephrologist was to be consulted by general practitioners or hospitalists in internal medicine, when creatinine clearance would fall below 60 mL/min. [40][41][42][43][44][45] This approach would enable the nephrologist to take effective measures to slow the progression of renal damage.…”

Section: Discussionmentioning

confidence: 99%

“…[40][41][42][43][44][45] In the past, various guidelines recommended that the nephrologist was to be consulted by general practitioners or hospitalists in internal medicine, when creatinine clearance would fall below 60 mL/min. [40][41][42][43][44][45] This approach would enable the nephrologist to take effective measures to slow the progression of renal damage. However, if we consider the percentage of patients with this indication in the current general population, we understand that the systematic application of this recommendation would have a dramatic impact on the territorial networks of renal care.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Referral to sub-specialists: who have the most to gain from early specialist intervention among patients with markers of renal disease?

Meschi

Esposti

et al. 2013

Ital J Med

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Referral to sub-specialists: who have the most to gain from early specialist intervention among patients with markers of renal disease?

Meschi

Esposti

et al. 2013

Ital J Med

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“…Despite increased awareness, CKD remains underdiagnosed, and its complications are poorly recognized in primary care (4). Almost one in four patients in the United Kingdom present to nephrology care within 3 mos of requiring renal replacement therapy (RRT) (5), with poor outcomes in terms of morbidity and mortality, as well as compromised ability to make timely plans regarding access, modality, or appropriateness of RRT (6). The vast majority of patients with CKD are treated solely through primary care, with one study finding that less than 4% of patients with CKD, identified from routine blood tests, were receiving nephrology care (7).…”

Section: W E Read With Interest the Articles Regarding Egfr Reportingmentioning

confidence: 99%

Perspectives on eGFR reporting from the Interface between Primary and Secondary Care

Cheung

Bhandari

2009

Clinical Journal of the American Society of Nephrology

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The introduction of estimated GFR (eGFR) reporting based on the Modification of Diet in Renal Disease (MDRD) equation has caused much debate regarding its value in the wider community. In particular, automated reporting of eGFR by laboratories has led to concern that it is being used as a "covert " screening tool, in populations in which the MDRD equation has known inaccuracies. There is a fear of creating a population of "worried well, " with potential impact on patients and implications for the use of resources. It is established that in certain groups, chronic kidney disease confers a greatly increased risk of cardiovascular disease, yet risk factors remain inadequately managed. We believe that eGFR reporting allows the opportunity to stratify risk and improve outcome among a wide population.

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“…Those patients who present late (<3 months prior to commencing dialysis) have poorer outcomes in terms of morbidity and mortality, spend significantly more time in hospital and are less likely to remain in employment [16][17][18][19]. In addition, the chance to delay the onset of dialysis has been lost and it is estimated that a reduction in the rate of decline in renal function by as little as 10% in patients with a GFR <60 ml/min would equate to saving in excess of $9 billion over a 10-year period in the USA [20].…”

Section: Introductionmentioning

confidence: 99%

Primary care-based disease management of chronic kidney disease (CKD), based on estimated glomerular filtration rate (eGFR) reporting, improves patient outcomes

Richards

Harris

Whitfield

et al. 2007

Nephrology Dialysis Transplantation

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Background. The majority of patients with chronic kidney disease (CKD) stages 3-5 are managed within primary care. We describe the effects, on patient outcomes, of the introduction of an algorithm-based, primary care disease management programme (DMP) for patients with CKD based on automated diagnosis using estimated glomerular filtration rate (eGFR) reporting. Results. Four hundred and eighty-three patients with CKD stage 4 or 5 were enrolled in the programme. There were significant improvements in the following parameters, expressed as median values (interquartile range) after 9 months in the programme, compared to baseline and percentage values patients achieving target at 9 months: total cholesterol 4.2 (3.45-5.0) mmol/l versus 4.6 (3.9-5.4) mmol/l (P < 0.01), 75.0% versus 64.5% (P < 0.001); LDL 2.2 (1.6-2.8) mmol/l versus 2.5 (1.9-3.2) mmol/l (P < 0.01), 81.9% versus 69.2% (P < 0.05); systolic blood pressure 130 (125-145) mmHg versus 139 (124-154) mmHg (P < 0.05), 56.2% versus 37.1% (P < 0.05) and diastolic blood pressure 71 (65-79) mmHg versus 76 (69-84) mmHg (P < 0.01), 68.4% versus 90.3% (P < 0.01).The median fall (interquartile range) in eGFR in the 9 months prior to joining the programme was 3.69 (1.49-7.46) ml/min/1.73 m 2 compared to 0.32 (−2.61-3.12) ml/min/1.73 m 2 in the 12 months after enrolment (P < 0.001). One hundred and twenty-two patients experienced a fall in eGFR of ≥5 ml/min/1.73 m 2 , median 9.90 (6.55-12.36) ml/min/1.73 m 2 in the 9 months prior to joining the programme, whilst in the 12 months after enrolment, their median fall in eGFR was −1.70 (−6.41-1.64) ml/min/1.73 m 2 (P < 0.001). In the remaining patients, the median fall in eGFR was 1.92 (0.41-3.23) ml/min/1.73 m 2 prior to joining the programme and 0.86 (−1.03-3.53) ml/min/1.73 m 2 in the 12 months after enrolment (P = 0.082). Conclusions. These data suggest that chronic disease management in this form is an effective method of identifying and managing patients with CKD within the UK. The improvement in cardiovascular risk factors and reduction in the rate of decline of renal function potentially have significant health benefits for the patients and should result in cost savings for the health economy.

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Late referral for dialysis: improving the management of chronic renal disease

Cited by 56 publications

References 20 publications

Referral to sub-specialists: who have the most to gain from early specialist intervention among patients with markers of renal disease?

Referral to sub-specialists: who have the most to gain from early specialist intervention among patients with markers of renal disease?

Perspectives on eGFR reporting from the Interface between Primary and Secondary Care

Primary care-based disease management of chronic kidney disease (CKD), based on estimated glomerular filtration rate (eGFR) reporting, improves patient outcomes

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