Automated Reporting of Estimated Glomerular Filtration Rate Alters Referral Patterns to a Nephrology Clinic

Abstract

An estimated 11% to 25% of adults in the United States have chronic kidney disease (CKD). In 2002, the National Kidney Foundation published a 5-stage classification of CKD based on estimated glomerular filtration rate (eGFR) intending to improve identification and management of prevalent cases (National Kidney Foundation, Am J Kidney Dis. 2002;39:S1–266). Nephrologists anticipated that the reporting of estimated GFR would improve early detection of CKD. The authors hypothesized that automatic eGFR reporting in our institution would subsequently result in increased new nephrology outpatient referrals at an earlier stage of CKD. The authors found that the proportion of referrals identifying earlier stages of CKD (eGFR greater than 45mL/min) increased significantly for 2 years following the institution of eGFR reporting but was not sustained (P=0.018); this trend was most obvious in African American women. No significant trend was seen with respect to age. The authors discuss potential reasons for automated eGFR reporting not leading to a sustained increase in nephrology referrals.