Referring patients with chronic kidney disease back to primary care: a criteria-based analysis in outpatient renal clinics

Carola Van Dipten,Davy Gerda Hermina Antoin Van Dam,Nynke Dorothea Scherpbier-De Haan,Willem Jan Jozef Assendelft,Jacobus Franciscus Maria Wetzels,Marcus Matheus Hendrik Hermans,Marcus Antonius Gerard Jan Ten Dam,Wilhelmus Joannes Carolus De Grauw

doi:10.1186/s12882-021-02367-1

Abstract

BackgroundThe increased demand for nephrology care for patients with chronic kidney disease (CKD) necessitates a critical review of the need for secondary care facilities and the possibilities for referral back to primary care. This study aimed to evaluate the characteristics and numbers of patients who could potentially be referred back to primary care, using predefined criteria developed by nephrologists and general practitioners.MethodWe organised a consensus meeting with eight nephrologists and two general practitioners to define the back referral (BR) criteria, and performed a retrospective cohort study reviewing records from patients under nephrologist care in three hospitals.ResultsWe reached a consensus about the BR criteria. Overall, 78 of the 300 patients (26%) in the outpatient clinics met the BR criteria. The characteristics of the patients who met the BR criteria were: 56.4% male, a median age of 70, an average of 3.0 outpatients visits per year, and a mean estimated glomerular filtration rate of 46 ml/min/1,73m2. Hypertension was present in 67.9% of this group, while 27.3% had diabetes and 16.9% had cancer. The patients who could be referred back represented all CKD stages except stage G5. The most common stage (16%) was G3bA2 (eGFR 30 ≤ 44 and ACR 3 ≤ 30).ConclusionA substantial proportion of patients were eligible for referral back to primary care. These patients often have a comorbidity, such as hypertension or diabetes. Future research should focus on generalisability of the BR criteria, the feasibility of actual implementation of the back referral, follow-up assessments of renal function and patient satisfaction.

Highlights

The increased demand for nephrology care for patients with chronic kidney disease (CKD) necessitates a critical review of the need for secondary care facilities and the possibilities for referral back to primary care
Proportion and characteristics of patients who fulfilled the back referral (BR) criteria Study setting In a retrospective cohort study, we reviewed the records of patients under nephrologist care in three hospitals (VieCurie Medical Center (VMC) in Venlo, and Canisius Wilhelmina Hospital (CWH) and Radboud university medical center (RUMC) in Nijmegen)
Taking the starting point that patients with lessprogressive moderate or even stable advanced CKD can be managed in primary care, we developed criteria for back referrals

Summary

Introduction

The increased demand for nephrology care for patients with chronic kidney disease (CKD) necessitates a critical review of the need for secondary care facilities and the possibilities for referral back to primary care. The rising prevalence and incidence of CKD will increase the number of referrals made to nephrology practitioners [6,7,8], increasing healthcare costs and posing a burden for both patients and nephrologists [9, 10]. It is questionable whether many of the referred patients with CKD need long-term care from a nephrologist. The increased demand for hospital care necessitates a periodical, broadly supported, criteria-based critical review of patients in secondary care facilities, together with an evaluation of the possibilities for referral back to primary care where possible

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