Only 58% of patients with chronic kidney disease (CKD) at high risk for progression to kidney failure receive timely nephrology referral, a new study finds, which means many patients are missing a crucial opportunity for advanced care.

Investigators calculated patients’ individual risk of progressing to end-stage kidney disease within 5 years using the 4-variable kidney failure risk equation (KFRE) based on age, sex, estimated glomerular filtration rate (eGFR), and urinary albumin to creatinine ratio (UACR). Among 156,733 primary care patients with CKD (mean age, 74.6 years; 58.6% female; 55.2% White) in a nationwide claims database, 134,716 patients (86.0%) had a low KFRE risk score (3% or lower) and 22,017 patients (14%) had an elevated KFRE risk score (above 3%). Of these, just 11.6% and 32.4%, respectively, had a nephrologist visit within 1 year. Even among patients with a KFRE risk score above 10%, only 41.5% visited a nephrologist within 1 year, Jonathan H. Chen, MD, PhD, of Stanford University in Palo Alto, California, and colleagues reported in JAMA Network Open. For the highest risk group with a KFRE score of 90% to 100%, just 57.7% had a nephrology visit within 1 year.

“This gap in care demonstrates a clear need for strategies that appropriately identify patients who could benefit from referral to nephrology care and to deliver targeted intervention to these patients,” Dr Chen’s team wrote.

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Reaching consensus on what KFRE threshold defines high risk and monitoring other important laboratory-based indicators could help primary care clinicians identify and refer patients whose high risk for CKD progression may not be apparent from eGFR alone, the investigators suggested.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Wang M, Peter SS, Chu CD, et al. Analysis of specialty nephrology care among patients with chronic kidney disease and high risk of disease progression. JAMA Netw Open 5(8). Published online August 19, 2022. doi:10.1001/jamanetworkopen.2022.25797