The long-term impact of eGFR reporting on referral patterns

• Introduction of eGFR reporting led to a sustained increase in the number of patients referrals.
• Increased referrals led to an older patient cohort and a higher proportion of females.
• Further work is needed to evaluate if this will be translated into clinical benefit for patients.

BackgroundThe prognostic significance of CKD has driven the widespread introduction of automated estimated glomerular filtration rate (eGFR) reporting, and the incorporation of CKD in the revised Quality Outcomes Framework (QOF) of the General Medical Services (GMS) contract in the U.K.AimsTo assess the long-term impact of the introduction of these two initiatives, on patient referral numbers to a nephrology service.MethodsData was collected on the numbers and basic characteristics of all new patients referred from April 2005 to March 2011, to one NHS Health Board.ResultsIntroduction of eGFR reporting and CKD QOF domains was associated with a significant increase in the number of referrals, which was sustained. The initiatives also led to a sustained increase in the mean age of the patients at referral, predominantly due to an increase in the age of female patients referred. There was also an increase in the proportion of female patients referred. In the immediate aftermath of the introduction of change there was a transient decrease in the average eGFR at referral, a decrease in age of patients referred with an eGFR < 15 ml/min and an increase in the eGFR of patients > 70 yrs of age.ConclusionsThe data demonstrates significant and sustained increase in numbers of referrals. In the short term this was associated with a reduction in referral of elderly patients with stage 5 CKD and an increase in elderly patients with mild renal impairment. In the longer term we saw an increase in referral of an older female population.