Chronic kidney disease referral practices among non-nephrology specialists: A single-centre experience

• In our centre, only a minority of CKD patients were referred to nephrology.
• Younger male patients with CKD4 were more likely to be referred.
• Urine investigations remain largely underutilised.
• Urine tests were more likely to occur in diabetes, CKD3B or worse and if referred.

BackgroundEarly referral of CKD patients to nephrology teams (NT) is vital to identify patients most likely to progress, delay decline of excretory function, and provide planned RRT. Unfortunately, many are still being referred late.MethodsWe conducted a retrospective analysis to investigate referral rates, predictors of non-referral, and performed urine investigations in hospitalised CKD patients.ResultsOut of 388 patients studied, 5.6%, 11.4%, and 16.4% in CKD3A, 3B, and 4 + 5, respectively, were referred to an NT upon discharge (CKD3A vs. CKD4 + 5, p = 0.016). For every additional year of age, the odds of being referred decreased by 5% (OR: 0.95, CI: 0.92–0.98, p = 0.003). Patients were more likely to be referred to an NT if they were males (OR: 2.31, CI: 1.09–4.90, p = 0.029) and having reached CKD 4 + 5 (OR: 3.99, CI: 1.58–10.10, p = 0.003). Only 28.8%, 43.9%, and 50.7% of patients with CKD3A, 3B, and 4 + 5 were followed up with urine investigations after discharge (p = 0.001). CKD stage 3B (OR: 3.54, CI: 1.23–10.19, p = 0.019), CKD stage 4 + 5 (OR: 6.06, CI: 1.69–21.67, p = 0.006), DM (OR: 6.28, CI: 2.38–16.58, p < 0.0001), and having been referred to a NT (OR: 20.95, CI: 3.54–123.92, p = 0.001) were independent predictors for having urine investigations.ConclusionThe highest rate of referral was achieved in males, younger age group, and those who have reached CKD stage 4 + 5. Urine tests remain largely underutilised and only a minority (16.4%) of patients with an eGFR < 30 mL/min/1.73 m2 were referred to a NT.