Rise in First Nephrology Visits Linked to eGFR Reporting

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Reporting of estimated glomerular filtration rate (eGFR) is associated with an increase in first nephrology visits, especially among individuals with more severe renal dysfunction, according to researchers.

The finding is based on a community-based cohort study that included 1,135,968 individuals identified from a laboratory registry in Alberta, Canada. Reporting of eGFR in the province was implemented in outpatient settings as of October 15, 2004.

Following eGFR reporting, the rate of first outpatient visits to a nephrologist for patients with CKD (eGFR below 60 mL/min/1.73 m2) increased by 17.5 visits per 10,000 CKD patients per month, which translated into a significant 68.4% increase from baseline, investigators reported in the Journal of the American Medical Association (2010;303:1151-1158).

In addition, among patients with an eGFR below 30, the rate of first nephrologist visits increased by 134.4 visits per 10,000 CKD patients per month. The increase was mostly observed in women, those with hypertension, diabetes, and other comorbidities, and patients aged 46-65 years and those aged 86 years and older.

The researchers, led by Brenda R. Hemmelgarn, MD, PhD, of the University of Calgary in Alberta, observed no association between reporting of eGFR and increased rates of internal medicine or general practitioner visits or increased use of ACE inhibitors or angiotensin receptor blockers among patients with CKD and proteinuria or a subgroup limited to patients with diabetes.

In an accompanying editorial (pp. 1201-1203), Richard J. Glassock, MD, of the David Geffen School of Medicine at the University of California-Los Angeles, pointed to problems with the current use of eGFR thresholds to define CKD. For example, using an eGFR of less than 60 to define CKD has been challenged as not being appropriate for people of more advanced age, particularly women, because of the normal decline in eGFR with aging, he noted.

The current eGFR-dominant formulation for defining and classifying generic CKD “requires an urgent overhaul,” Dr. Glassock wrote. He added that routine reporting of eGFR “needs reconsideration (regardless of the formula used), and primary care physicians and nephrologists should work together to ensure that referrals for subspecialty care are timely and appropriate.”

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