Primary care referrals to nephrology in patients with advanced kidney disease

Dharod, Ajay; Bundy, Richa; Russell, Gregory B.; Rice, William Y; Golightly, Cameron E; Rosenthal, Gary E.; Freedman, Barry I.

doi:10.37765/ajmc.2020.88526

Cited by 8 publications

(8 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Recently Dharod et al reviewed records of 133,913 patients on follow-up by 185 primary care practices (61 practices). Out of these, 54.6% were not referred to nephrology [ 18 ]. Alfarhan et al found that the most important physician and hospital factors are insufficient conduction of pre-dialysis care and education (63.7%) and late referral to a nephrologist (56.6%) [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

Delay in Permanent Vascular Access Formation and Referral to a Nephrologist in Incident Hemodialysis Patients: A Single Center Experience

Khatri¹,

Nasir²,

Dhrolia³

et al. 2021

Cureus

View full text Add to dashboard Cite

Objective: This study assessed the factors associated with delayed referral to a nephrologist and delay in formation of a permanent vascular access in incident hemodialysis (HD) patients. Methods: This prospective cross-sectional study was conducted from February 2021 to July 2021 on end stage renal disease (ESRD) patients receiving maintenance hemodialysis (MHD) at our center. Data were collected at the bedside during the HD session about a referral to a nephrologist, about when they were asked for permanent vascular access formation and the reason for the delay in its formation. Results: Out of 296 patients recruited in our study, 168 (56.8%) were male and 128 (43.2) were female. The mean age was 53.5±15 years (minimum of 19 years and maximum of 90 years). The most common reason for refusal of making permanent vascular access [arterio-venous fistula (AVF) or arterio-venous graft (AVG)] was fear of pain in our patients 65 (43.3%) followed by the denial of the disease 32 (21.3%). Among the study subjects, 231 (78%) patients were referred to the nephrologist immediately or within one month of their diagnosis. Some 152 (51.4%) of the patients were not in favor of making AVF whereas 151 (51%) refused for starting HD, hence most of our patients 181 (61.1%) initiated HD in emergency by a central venous catheter (CVC). Conclusion: Early referral should be done by primary care physicians (PCPs) for the timely management of CKD patients. As CKD is a progressive disease, it requires special attention by a nephrologist for adjustment of patient’s medications, timely follow-up, counseling, the early formation of AVF for HD, and planning for renal transplant. In our study, the majority of our patients initiated their HD via CVC because of the delayed visit to a nephrologist. Most patients were asked for AVF formation on the same day of presentation to our nephrology unit as they had advanced CKD (Stage 5) 134 (51.4%). Most patients in our study delayed AVF formation 152 (51.4%). With timely referral to a nephrologist, the nephrologist will be able to do better and repeated counseling about the disease, its progression, and the need for permanent vascular access for initiation of HD while patients and their families will get more time to make decisions.

show abstract

Section: Discussionmentioning

confidence: 99%

Delay in Permanent Vascular Access Formation and Referral to a Nephrologist in Incident Hemodialysis Patients: A Single Center Experience

Khatri¹,

Nasir²,

Dhrolia³

et al. 2021

Cureus

View full text Add to dashboard Cite

show abstract

“…The 2022 ADA guidelines and KDIGO CKD Working Group recommend that patients with advanced kidney disease (eGFR < 30 mL/min/1.73 m 2 ) also be referred to a kidney specialist. 61 , 62 …”

Section: Timely Diagnosis Of Ckd Requires Effective Multidisciplinary...mentioning

confidence: 99%

“…63 Study results from an US academic healthcare system found that only 45.4% of patients actively visiting their primary care clinicians are referred to a nephrologist, but the study did not specify whether patients who were referred had an eGFR < 30 mL/min/1.73 m 2 . 62 A qualitative study by Greer et al 64 identified key barriers to appropriate nephrology referral of patients with CKD: lack of timely and adequate information exchange between nephrologists and primary care clinicians; limited access to nephrologists; lack of clarity regarding clinical roles and responsibilities; challenging working relationships with nephrologists; and, lack of trust between patients and nephrologists. 63 These findings highlight the multifactorial approach required to enhance cohesion among primary care clinicians, endocrinologists, and nephrologists to improve clinical outcomes for patients with T2D and CKD.…”

Section: Timely Diagnosis Of Ckd Requires Effective Multidisciplinary...mentioning

confidence: 99%

Beyond Blood Glucose and Blood Pressure Control in Type 2 Diabetes: Alternative Management Strategies to Prevent the Development and Progression of CKD

Wright

Urquhart²,

Brunton³

2023

J Prim Care Community Health

View full text Add to dashboard Cite

Chronic kidney disease associated with Type 2 diabetes is linked to significant increase in morbidity, reduced quality of life, and early death. Current guidelines recommend targets for the management of hyperglycemia, hypertension, and dyslipidemia but there remains a residual risk of chronic kidney disease progression and adverse cardiovascular outcomes in patients with Type 2 diabetes. The 2022 consensus report from the American Diabetes Association and Kidney Disease: Improving Global Outcomes support the use of sodium–glucose co-transporter 2 inhibitors and nonsteroidal mineralocorticoid receptor antagonists to improve kidney and cardiovascular outcomes. Coordination between those working in the primary care setting and those in endocrinology and nephrology clinics may optimize the prevention of chronic kidney disease progression in patients with Type 2 diabetes. Nurse practitioners, physician assistants, and primary care physicians play an important role in making timely patient referrals to kidney specialists. This article explores the use of novel therapies capable of reducing the risk of cardiovascular disease and chronic kidney disease progression beyond what can be achieved with control of blood glucose, blood pressure, and lipid levels. It also discusses the importance of monitoring at-risk patients to facilitate early diagnosis and initiation of effective kidney-protective therapy. [Media: see text] [Figure: see text]

show abstract

“…Patient transition from primary to secondary specialist care usually occurs following referral from a primary care clinician; therefore, the latter are often considered gatekeepers to further care [ 33 ]. When a patient with T2DM visits their primary care clinician, if all confirmatory kidney screening tests point to CKD, they should be referred to a nephrologist [ 34 ], particularly when the test results show UACR > 300 mg/g and/or eGFR < 30 mL/min/1.73 m 2 . Although the criteria for when this should happen are included in the ADA-KDIGO 2022 consensus report [ 12 ] (Fig.…”

Section: Multidisciplinary Team Approach To Reducing Risk Of Chronic ...mentioning

confidence: 99%

Optimizing Multidisciplinary Care of Patients with Chronic Kidney Disease and Type 2 Diabetes Mellitus

et al. 2023

View full text Add to dashboard Cite

Diabetes is the leading cause of chronic kidney disease (CKD), a condition associated with significant morbidity and mortality. As these patients have a high risk of developing cardiovascular disease and end-stage kidney disease, there is a need for early detection and early initiation of appropriate therapeutic interventions that slow disease progression and prevent adverse outcomes. Due to the complex nature of diabetes and CKD management, a holistic, patient-centered, collaborative care approach delivered by a coordinated multidisciplinary team (ideally including a clinical pharmacist as part of a comprehensive medication management program) is needed. In this review, we discuss the barriers to effective care, the current multidisciplinary approach used for CKD prevention and treatment, and the potential ways that the multidisciplinary management of CKD associated with type 2 diabetes mellitus can be refined to improve patient outcomes.

show abstract

Primary care referrals to nephrology in patients with advanced kidney disease

Cited by 8 publications

References 22 publications

Delay in Permanent Vascular Access Formation and Referral to a Nephrologist in Incident Hemodialysis Patients: A Single Center Experience

Delay in Permanent Vascular Access Formation and Referral to a Nephrologist in Incident Hemodialysis Patients: A Single Center Experience

Beyond Blood Glucose and Blood Pressure Control in Type 2 Diabetes: Alternative Management Strategies to Prevent the Development and Progression of CKD

Optimizing Multidisciplinary Care of Patients with Chronic Kidney Disease and Type 2 Diabetes Mellitus

Contact Info

Product

Resources

About