Dataset Information

Nephrology Referral Based on Laboratory Values, Kidney Failure Risk, or Both: A Study Using Veterans Affairs Health System Data.

ABSTRACT:

Rationale & objective

Current guidelines for nephrology referral are based on laboratory criteria. We sought to evaluate whether nephrology referral patterns reflect current clinical practice guidelines and to estimate the change in referral volume if they were based on the estimated risk of kidney failure.

Study design

Observational cohort.

Setting & participants

Retrospective study of 399,644 veterans with chronic kidney disease (October 1, 2015 through September 30, 2016).

Exposure

Laboratory referral criteria based on Veterans Affairs/Department of Defense guidelines, categories of predicted risk for kidney failure using the Kidney Failure Risk Equation, and the combination of laboratory referral criteria and predicted risk.

Outcome

Number of patients identified for referral.

Analytical approach

We evaluated the number of patients who were referred and their predicted 2-year risk for kidney failure. For each exposure, we estimated the number of patients who would be identified for referral.

Results

There were 66,276 patients who met laboratory indications for referral. Among these patients, 11,752 (17.7%) were referred to nephrology in the following year. The median 2-year predicted risk of kidney failure was 1.5% (interquartile range, 0.3%-4.7%) among all patients meeting the laboratory referral criteria. If referrals were restricted to patients with a predicted risk of ≥1% in addition to laboratory indications, the potential referral volume would be reduced from 66,276 to 38,229 patients. If referrals were based on predicted risk alone, a 2-year risk threshold of 1% or higher would identify a similar number of patients (72,948) as laboratory-based criteria with median predicted risk of 2.3% (interquartile range, 1.4%-4.6%).

Limitations

Missing proteinuria measurements.

Conclusions

The current laboratory-based guidelines for nephrology referral identify patients who are, on average, at low risk for progression, most of whom are not referred. As an alternative, referral based on a 2-year kidney failure risk exceeding 1% would identify a similar number of patients but with a higher median risk of kidney failure.

SUBMITTER: Duggal V

PROVIDER: S-EPMC9973036 | biostudies-literature | 2022 Mar

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Nephrology Referral Based on Laboratory Values, Kidney Failure Risk, or Both: A Study Using Veterans Affairs Health System Data.

Duggal Vishal V Montez-Rath Maria E ME Thomas I-Chun IC Goldstein Mary K MK Tamura Manjula Kurella MK

American journal of kidney diseases : the official journal of the National Kidney Foundation 20210824 3

<h4>Rationale & objective</h4>Current guidelines for nephrology referral are based on laboratory criteria. We sought to evaluate whether nephrology referral patterns reflect current clinical practice guidelines and to estimate the change in referral volume if they were based on the estimated risk of kidney failure.<h4>Study design</h4>Observational cohort.<h4>Setting & participants</h4>Retrospective study of 399,644 veterans with chronic kidney disease (October 1, 2015 through September 30, 2016 ...[more]

PMID: 34450193

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Dataset Information

Nephrology Referral Based on Laboratory Values, Kidney Failure Risk, or Both: A Study Using Veterans Affairs Health System Data.

Rationale & objective

Study design

Setting & participants

Exposure

Outcome

Analytical approach

Results

Limitations

Conclusions

Publications

Nephrology Referral Based on Laboratory Values, Kidney Failure Risk, or Both: A Study Using Veterans Affairs Health System Data.

Similar Datasets

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