ArticlePloS one2022
Trends in nephrology referral patterns for patients with chronic kidney disease: Retrospective cohort study.
Article in PloS one, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 1 of them a synthesis that pooled it.
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Who cites it
11 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Challenges and strategies for managing early-to-moderate chronic kidney disease in primary care: A systematic integrative review in high-income countries.The European journal of general practice · 2026Pooled it
- Derivation and Validation of Risk Prediction Models for Cardiovascular and Kidney Outcomes of Non-ST-Segment-Elevation Acute Coronary Syndrome in Patients With Chronic Kidney Disease.Journal of the American Heart Association · 2026Article
- Repositioning the Canadian CKD Clinic Network Through Structured Input and World Café Dialogue: A Conference Report.Canadian journal of kidney health and disease · 2026Article
- Comparison of risks and costs of undiagnosed and diagnosed chronic kidney disease patients after the initiation of kidney replacement therapy in subsequent years. A Hungarian nationwide study.Frontiers in medicine · 2026Article
- Referral patterns in the CKD.QLD Registry: A call for revisiting the definition of late referral.PloS one · 2026Article
- Cardiovascular-Kidney-Metabolic Multimorbidity Burden and Phenotype Differentially Influence Cardiovascular and Renal Risk in Advanced Chronic Kidney Disease.Cardiorenal medicine · 2026Article
- Initiatives to enhance referral patterns from primary care to specialist kidney care:a systematic review and meta-analysis.BMJ public health · 2025Article
- Nephrologist's Perceptions of Risk of Severe Chronic Kidney Disease and Outpatient Follow-up After Hospitalization With AKI: Multinational Randomized Survey Study.Canadian journal of kidney health and disease · 2025Article
- General practitioners' representation of early-stage CKD is a barrier to adequate management and patient empowerment: a phenomenological study.Journal of nephrology · 2024Article
- Nurse Practitioner Care Compared with Primary Care or Nephrologist Care in Early CKD.Clinical journal of the American Society of Nephrology : CJASN · 2023Article
- Rate and Risk Factors of Acute Myocardial Infarction after Debut of Chronic Kidney Disease-Results from the KidDiCo.Journal of cardiovascular development and disease · 2022Article
Corrections and comments
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Authors and funding
16 authors.
Funding
Abstract
introductionInformation on early, guideline discordant referrals in nephrology is limited. Our objective was to investigate trends in referral patterns to nephrology for patients with chronic kidney disease (CKD).
methodsRetrospective cohort study of adults with ≥1 visits to a nephrologist from primary care with ≥1 serum creatinine and/or urine protein measurement <180 days before index nephrology visit, from 2006 and 2019 in Alberta, Canada. Guideline discordant referrals were those that did not meet ≥1 of: Estimated glomerular filtration rate (eGFR) ˂ 30 mL/min/1.73m2, persistent albuminuria (ACR ≥ 300 mg/g, PCR ≥ 500 mg/g, or Udip ≥ 2+), or progressive and persistent decline in eGFR until index nephrology visit (≥ 5 mL/min/1.73m2).
resultsOf 69,372 patients with CKD, 28,518 (41%) were referred in a guideline concordant manner. The overall rate of first outpatient visits to nephrology increased from 2006 to 2019, although guideline discordant referrals showed a greater increase (trend 21.9 per million population/year, 95% confidence interval 4.3, 39.4) versus guideline concordant referrals (trend 12.4 per million population/year, 95% confidence interval 5.7, 19.0). The guideline concordant cohort were more likely to be on renin-angiotensin system blockers or beta blockers (hazard ratio 1.14, 95% confidence interval 1.12, 1.16), and had a higher risk of CKD progression (hazard ratio 1.09, 95% confidence interval 1.06, 1.13), kidney failure (hazard ratio 7.65, 95% confidence interval 6.83, 8.56), cardiovascular event (hazard ratio 1.40, 95% confidence interval 1.35,1.45) and mortality (hazard ratio 1.58, 95% confidence interval 1.52, 1.63).
conclusionsA significant proportion nephrology referrals from primary care were not consistent with current guideline-recommended criteria for referral. Further work is needed to identify quality improvement initiatives aimed at enhancing referral patterns of patients with CKD.
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