Nephrology referrals identify many patients at low risk for progression

(HealthDay)—Current guidelines for nephrology referral identify many patients at low risk for progression, according to a study published online Aug. 24 in the American Journal of Kidney Diseases.

Vishal Duggal, M.D., from the Veterans Affairs Palo Alto Health Care System in California, and colleagues conducted an observational cohort study involving 399,644 veterans with chronic kidney disease from Oct. 1, 2015, to Sept. 30, 2016, to examine the number of patients identified for nephrology referral and their predicted risk for kidney failure.

The researchers found that 66,276 patients met laboratory indications for referral; 17.7 percent of these patients were referred to nephrology in the following year. Among all patients meeting laboratory referral criteria, the median two-year predicted risk for kidney failure was 1.5 percent. Potential referral volume would be reduced from 66,276 to 38,229 patients if referral was restricted to patients with predicted risk ≥1 percent in addition to laboratory indications. Basing referrals on predicted risk alone, a two-year risk threshold of 1 percent or higher would identify a similar number of patients as laboratory-based criteria, with a median predicted risk of 2.3 percent (72,948 patients).

"A significant proportion of patients identified by laboratory-based indications for nephrology referral have a predicted risk of kidney failure less than 1 percent," the authors write. "These findings may inform clinical decision support development to target nephrology referrals to patients most likely to benefit."

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