Nephrologist referrals of older patients with chronic kidney disease in Singapore: a cross-sectional study.

Wei Beng Tan,Anna Szücs,Goh Lay Hoon,Sarah M Burkill,Ong Shih Hui,Doris Young

doi:10.3399/bjgpo.2021.0155

Abstract

Chronic kidney disease (CKD) is common in the older population. By 2035, approximately one-quarter of Singapore residents are expected to have CKD. Many of these patients are not referred to nephrologists. To compare the characteristics of older patients (aged ≥65 years) with CKD stage ≥3B in the referral and non-referral groups. A cross-sectional study in the primary care organisation National University Polyclinics (NUP), Singapore. Retrospective data were extracted from the electronic health records of patients with CKD (aged ≥65 years) with CKD stage ≥3B. From 1 January-31 December 2018, a total of 1536 patients aged ≥65 years were diagnosed with CKD stage ≥3B (non-referral group = 1179 versus referral group = 357). The mean patient age in the non-referral group (78.4 years) was older than that in the referral group (75.9 years) (P<0.001). Indian older patients were referred more compared with their Chinese counterparts (P = 0.008). The non-referral group was prescribed significantly less fibrate, statins, insulin, sulfonylureas, dipeptidyl peptidase-4 (DPP4) inhibitors, and antiplatelet than the referral group (P<0.05), but only the difference in fibrates remained significant on subsequent multivariate analysis. This study demonstrates that there is a considerable number of older patients with CKD exclusively managed in the primary care setting (n = 1179) and that referrals primarily depend on demographic factors, namely age and ethnic group, rather than medical determinants of CKD severity or case complexity.

Highlights

Chronic kidney disease (CKD) is one of the common presentations among the older population in the primary care setting[1–3]
This study suggests that the majority of elderly patients can be safely and appropriately managed in the primary care setting
Torreggiani et al 2021 revealed that the majority of the causes of CKD are multifactorial diseases, nephroangiosclerosis, and diabetes-associated kidney disease, the variant with low proteinuria, which increases with age[17]. This variant accounts for over 80% of the diagnoses in patients aged 80 or older

Summary

Introduction

Chronic kidney disease (CKD) is one of the common presentations among the older population in the primary care setting[1–3]. In France, an epidemiological survey of the Île-de-France area showed that the incidence rate among patients above 75 years was almost seven times that of patients aged 20–39 years (619 versus 92 new cases/million population) and more than double that of patients aged 40–59 years (619 versus 264 new cases/million population)[5]. By 2035, approximately one-quarter of Singapore residents are expected to have CKD This trend will likely affect how we manage CKD patients in the primary care community[6]. Chronic kidney disease (CKD) is common in the elderly population. Many of these patients are not referred to nephrologists

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Discussion

Conclusion