OBJECTIVES: Optimizing care for patients with advanced kidney disease requires close collaboration between primary care physicians (PCPs) and nephrologists. Factors associated with PCP referral to nephrology were assessed in patients with estimated glomerular filtration rates (eGFRs) less than 30 mL/min/1.73 m2. STUDY DESIGN: Electronic health record review at an integrated health care network. METHODS: Factors associated with referral status were identified using Fisher's exact tests, t tests, and multivariable logistic regression. RESULTS: Of 133,913 patients regularly seeing PCPs between October 2017 and September 2019, 1119 had a final eGFR less than 30 mL/min/1.73 m2 and were not on renal replacement therapy. Care was provided by 185 PCPs (61 practices). Analyses were restricted to the 97.1% (n = 1087) of patients who were African American or European American. Of these, 54.6% had not been referred to nephrology. Nonreferred patients had higher numbers of PCP visits (P = .004). In contrast, referred patients were younger, were more often African American, and had PCPs at the academic medical center (all P < .0001). Referred patients had more complex medical histories with higher Charlson Comorbidity Index scores, more hospitalizations, and greater numbers of inpatient days (all P < .0001). Analyses restricted to patients with serum creatinine concentration of at least 2 mg/dL yielded similar results. Age, number of hospitalizations, ancestry, academic physician, diabetic end-organ damage, peripheral vascular disease, and tumor status were independent predictors of nephrology referral. CONCLUSIONS: Impediments to appropriately timed nephrology referrals persist in patients with high likelihoods of progression to end-stage kidney disease. Improved access to nephrology care should be rapidly addressed to meet targets in the 2019 Executive Order on Advancing American Kidney Health.
OBJECTIVES: Optimizing care for patients with advanced kidney disease requires close collaboration between primary care physicians (PCPs) and nephrologists. Factors associated with PCP referral to nephrology were assessed in patients with estimated glomerular filtration rates (eGFRs) less than 30 mL/min/1.73 m2. STUDY DESIGN: Electronic health record review at an integrated health care network. METHODS: Factors associated with referral status were identified using Fisher's exact tests, t tests, and multivariable logistic regression. RESULTS: Of 133,913 patients regularly seeing PCPs between October 2017 and September 2019, 1119 had a final eGFR less than 30 mL/min/1.73 m2 and were not on renal replacement therapy. Care was provided by 185 PCPs (61 practices). Analyses were restricted to the 97.1% (n = 1087) of patients who were African American or European American. Of these, 54.6% had not been referred to nephrology. Nonreferred patients had higher numbers of PCP visits (P = .004). In contrast, referred patients were younger, were more often African American, and had PCPs at the academic medical center (all P < .0001). Referred patients had more complex medical histories with higher Charlson Comorbidity Index scores, more hospitalizations, and greater numbers of inpatient days (all P < .0001). Analyses restricted to patients with serum creatinine concentration of at least 2 mg/dL yielded similar results. Age, number of hospitalizations, ancestry, academic physician, diabetic end-organ damage, peripheral vascular disease, and tumor status were independent predictors of nephrology referral. CONCLUSIONS: Impediments to appropriately timed nephrology referrals persist in patients with high likelihoods of progression to end-stage kidney disease. Improved access to nephrology care should be rapidly addressed to meet targets in the 2019 Executive Order on Advancing American Kidney Health.
Authors: Robert G Nelson; Morgan E Grams; Shoshana H Ballew; Yingying Sang; Fereidoun Azizi; Steven J Chadban; Layal Chaker; Stephan C Dunning; Caroline Fox; Yoshihisa Hirakawa; Kunitoshi Iseki; Joachim Ix; Tazeen H Jafar; Anna Köttgen; David M J Naimark; Takayoshi Ohkubo; Gordon J Prescott; Casey M Rebholz; Charumathi Sabanayagam; Toshimi Sairenchi; Ben Schöttker; Yugo Shibagaki; Marcello Tonelli; Luxia Zhang; Ron T Gansevoort; Kunihiro Matsushita; Mark Woodward; Josef Coresh; Varda Shalev Journal: JAMA Date: 2019-12-03 Impact factor: 56.272
Authors: Ping Liu; Robert R Quinn; Matthew J Oliver; Paul E Ronksley; Brenda R Hemmelgarn; Hude Quan; Swapnil Hiremath; Aminu K Bello; Peter G Blake; Amit X Garg; John Johnson; Mauro Verrelli; James M Zacharias; Samar Abd ElHafeez; Marcello Tonelli; Pietro Ravani Journal: Clin J Am Soc Nephrol Date: 2018-03-05 Impact factor: 8.237
Authors: Rajiv Saran; Bruce Robinson; Kevin C Abbott; Lawrence Y C Agodoa; Jennifer Bragg-Gresham; Rajesh Balkrishnan; Nicole Bhave; Xue Dietrich; Zhechen Ding; Paul W Eggers; Abduzhappar Gaipov; Daniel Gillen; Debbie Gipson; Haoyu Gu; Paula Guro; Diana Haggerty; Yun Han; Kevin He; William Herman; Michael Heung; Richard A Hirth; Jui-Ting Hsiung; David Hutton; Aya Inoue; Steven J Jacobsen; Yan Jin; Kamyar Kalantar-Zadeh; Alissa Kapke; Carola-Ellen Kleine; Csaba P Kovesdy; William Krueter; Vivian Kurtz; Yiting Li; Sai Liu; Maria V Marroquin; Keith McCullough; Miklos Z Molnar; Zubin Modi; Maria Montez-Rath; Hamid Moradi; Hal Morgenstern; Purna Mukhopadhyay; Brahmajee Nallamothu; Danh V Nguyen; Keith C Norris; Ann M O'Hare; Yoshitsugu Obi; Christina Park; Jeffrey Pearson; Ronald Pisoni; Praveen K Potukuchi; Kaitlyn Repeck; Connie M Rhee; Douglas E Schaubel; Jillian Schrager; David T Selewski; Ruth Shamraj; Sally F Shaw; Jiaxiao M Shi; Monica Shieu; John J Sim; Melissa Soohoo; Diane Steffick; Elani Streja; Keiichi Sumida; Manjula Kurella Tamura; Anca Tilea; Megan Turf; Dongyu Wang; Wenjing Weng; Kenneth J Woodside; April Wyncott; Jie Xiang; Xin Xin; Maggie Yin; Amy S You; Xiaosong Zhang; Hui Zhou; Vahakn Shahinian Journal: Am J Kidney Dis Date: 2019-02-21 Impact factor: 8.860
Authors: Andrew S Levey; Lesley A Stevens; Christopher H Schmid; Yaping Lucy Zhang; Alejandro F Castro; Harold I Feldman; John W Kusek; Paul Eggers; Frederick Van Lente; Tom Greene; Josef Coresh Journal: Ann Intern Med Date: 2009-05-05 Impact factor: 25.391