Limited referral to nephrologists from a tertiary geriatric outpatient clinic despite a high prevalence of chronic kidney disease and anaemia

Abstract

BackgroundChronic kidney disease (CKD) is increasing in prevalence world-wide with the largest growth being in the elderly. The aim of this study was to examine the prevalence of CKD in a geriatric outpatient clinic within a tertiary hospital and its association with anaemia and mortality with a focus on the referral patterns towards nephrologists.MethodsRetrospective study utilising administrative databases. The cohort was defined as all patients that attended the geriatric outpatient clinics of a single tertiary hospital within the first 3 months of 2006. Patients were followed for 18 months for mortality and referral to a nephrologist.ResultsThe mean Glomerular filtration rate (eGFR) of the 439 patients was 67.4 ± 29.1 mL/min/1.73 m2 (44% <60 mL/min/1.73 m2). 11.8% had a haemoglobin < 110 g/L, with anaemia being significantly associated with kidney function in those with a eGFR < 60 mL/min/1.73 m2 (p = 0.0092). Kidney function and anaemia were significantly associated with mortality on multivariate analysis (p = 0.019 and p = 0.0074). After 18 months, 8.8% of patients with CKD were referred to a nephrologist.ConclusionDespite a high prevalence of CKD in patients attending a geriatric outpatient clinic and its association with anaemia and mortality, few of these patients were referred to a nephrologist. An examination of the reasons behind this bias is required.

Influence of Nephrologist Care on Management and Outcomes in Adults with Chronic Kidney Disease

“…26 Furthermore, among over 400 geriatric ambulatory patients with mild to moderate CKD, only 8.8 % were referred to a nephrologist. 27 In contrast, in a study of 135 patients initiating dialysis, no association was found between age, gender or race and timing of nephrology referral, but private health insurance conferred a higher odds of nephrology referral compared with Medicare. Factors that might influence primary care providers' (PCP) referral of patients with CKD to nephrologists are not well understood.…”

Assessing Nephrological Competence among Geriatricians: A Proof of Concept Internet Survey

“…The fact that 10,5% of geriatricians asked for nephrological consultation only for stage 5 CKD patients and 30,9% only for stage 4 or 5 confirms findings pertaining to a tertiary geriatric outpatient clinic [ 16 ]. Paradoxically, comorbidity, i. e. an index of complexity of the health status, has been reported to characterize patients for whom general practitioners did not ask for nephrologic consultation [ 17 ].…”