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. 2022 Jun 24;23(1):225.
doi: 10.1186/s12882-022-02845-0.

Referral criteria for chronic kidney disease: implications for disease management and healthcare expenditure-analysis of a population-based sample

Simone Kiel #  1 , Gesine Weckmann #  2 , Jean-François Chenot  3 , Sylvia Stracke  4   5 , Jacob Spallek  6 , Aniela Angelow  3
Affiliations

Referral criteria for chronic kidney disease: implications for disease management and healthcare expenditure-analysis of a population-based sample

Simone Kiel et al. BMC Nephrol. .

Abstract

Background: Clinical practice guidelines recommend specialist referral according to different criteria. The aim was to assess recommended and observed referral rate and health care expenditure according to recommendations from: • Kidney Disease Improving Global Outcomes (KDIGO,2012) • National Institute for Health and Care Excellence (NICE,2014) • German Society of Nephrology/German Society of Internal Medicine (DGfN/DGIM,2015) • German College of General Practitioners and Family Physicians (DEGAM,2019) • Kidney failure risk equation (NICE,2021) METHODS: Data of the population-based cohort Study of Health in Pomerania were matched with claims data. Proportion of subjects meeting referral criteria and corresponding health care expenditures were calculated and projected to the population of Mecklenburg-Vorpommern.

Results: Data from 1927 subjects were analysed. Overall proportion of subjects meeting referral criteria ranged from 4.9% (DEGAM) to 8.3% (DGfN/DGIM). The majority of patients eligible for referral were ≥ 60 years. In subjects older than 60 years, differences were even more pronounced, and rates ranged from 9.7% (DEGAM) to 16.5% (DGfN/DGIM). Estimated population level costs varied between €1,432,440 (DEGAM) and €2,386,186 (DGfN/DGIM). From 190 patients with eGFR < 60 ml/min, 15 had a risk of end stage renal disease > 5% within the next 5 years.

Conclusions: Applying different referral criteria results in different referral rates and costs. Referral rates exceed actually observed consultation rates. Criteria need to be evaluated in terms of available workforce, resources and regarding over- and underutilization of nephrology services.

Keywords: Chronic kidney disease; Guideline recommendations; Health care costs; Nephrology referral; Referral.

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Conflict of interest statement

G. Weckmann, S. Stracke and J.-F. Chenot are authors of the DEGAM guideline Management of patients with chronic non-dialysis kidney disease in general practice. All other authors do not have any conflict of interests.

Figures

Fig. 1
Fig. 1
Flow chart of the study population selection. * some participants fulfilled multiple criteria
Fig. 2
Fig. 2
Diagram showing participants referred to a nephrologist according to guidelines/recommendations and participants actually consulting a nephrologist within 1 year prior to study examination (SHIP-2). DGfN/DGIM: German Society of Nephrology/German Society of Internal Medicine; KDIGO: Kidney Disease Improving Global Outcomes; NICE: National Institute for Health and Care Excellence; DEGAM: German College of General Practitioners and Family Physicians
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