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Impact of estimated GFR reporting on late referral rates and practice patterns for end-stage kidney disease patients: a multilevel logistic regression analysis using the Australia and New Zealand dialysis and transplant registry (ANZDATA)

Foote, Celine, Clayton, Philip A., Johnson, David W., Jardine, Meg, Snelling, Paul and Cass, Alan (2014). Impact of estimated GFR reporting on late referral rates and practice patterns for end-stage kidney disease patients: a multilevel logistic regression analysis using the Australia and New Zealand dialysis and transplant registry (ANZDATA). American Journal of Kidney Diseases,64(3):359-366.

Document type: Journal Article
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IRMA ID 75039815xPUB294
Title Impact of estimated GFR reporting on late referral rates and practice patterns for end-stage kidney disease patients: a multilevel logistic regression analysis using the Australia and New Zealand dialysis and transplant registry (ANZDATA)
Author Foote, Celine
Clayton, Philip A.
Johnson, David W.
Jardine, Meg
Snelling, Paul
Cass, Alan
Journal Name American Journal of Kidney Diseases
Publication Date 2014
Volume Number 64
Issue Number 3
ISSN 0272-6386   (check CDU catalogue open catalogue search in new window)
Scopus ID 2-s2.0-84908120506
Start Page 359
End Page 366
Total Pages 8
Place of Publication United States
Publisher W.B. Saunders Co.
HERDC Category C1 - Journal Article (DIISR)
Abstract Background
Late referral for renal replacement therapy (RRT) leads to worse outcomes. In 2005, estimated glomerular filtration rate (eGFR) reporting began in Australasia, with an aim of substantially increasing earlier disease detection.

Study Design

Observational cohort study using the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) data.

Setting & Participants

All patients commencing RRT in Australasia between January 1, 1999, and December 31, 2010. We excluded the period between December 31, 2004, and January 1, 2007, to allow for practice change.

Factor

Introduction of eGFR reporting.

Outcomes

Primary outcome was late referral defined as commencing RRT within 3 months of nephrology referral. Secondary outcomes included initial RRT modality and prepared access at hemodialysis therapy initiation.

Measurements

Late referral rates per era were determined and multilevel logistic regression was used to identify late referral predictors.

Results

We included 25,009 patients. Overall, 3,433 (25.3%) patients were referred late in the pre-eGFR era compared with 2,464 (21.6%) in the post-eGFR era, for an absolute reduction of 3.7% (95% CI, 2.7%-4.8%; P < 0.001). After adjustments for age, body mass index, race, comorbid conditions, and primary kidney disease, adjusted late referral rates were 25.8% (95% CI, 23.3%-28.3%) and 21.8% (95% CI, 19.2%-24.4%) in the pre- and post-eGFR eras, respectively, for a difference of 4.0% (95% CI, 1.2%-6.8%; P = 0.005). Late referral risk was attenuated significantly post-eGFR reporting (OR, 1.30; 95% CI, 1.12-1.51) compared to pre-eGFR reporting (OR, 2.15; 95% CI, 1.88-2.46) for indigenous patients. Late referral rates decreased for older patients but increased slightly for younger patients (P = 0.001 for interaction between age and era). There was no impact on initial RRT modality or prepared access rates at hemodialysis therapy initiation between eras.

Limitations

Residual confounding could not be excluded.

Conclusions

eGFR reporting was associated with small reductions in late referral, but more than 1 in 5 patients are still referred late. Other initiatives to increase timely referral warrant investigation.
Keywords Estimated glomerular filtration rate (eGFR)
automatic
late referral
practice patterns
renal replacement therapy (RRT)
nephrology referral
registry study
DOI http://dx.doi.org/10.1053/j.ajkd.2014.02.023   (check subscription with CDU E-Gateway service for CDU Staff and Students  check subscription with CDU E-Gateway in new window)
 
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