Late referral for assessment of renal failure

Area of Science:

• Nephrology
• Public Health
• Clinical Medicine

Background:

• Current guidelines recommend nephrologist referral for adult patients with serum creatinine > 150 µmol/l.
• Understanding referral patterns is crucial for managing chronic kidney disease (CKD) progression.

Purpose of the Study:

• To evaluate the rate of nephrologist referral in Northern Ireland for patients exceeding the recommended serum creatinine threshold.
• To identify factors influencing referral patterns in this patient cohort.

Main Methods:

• Retrospective analysis of 19,286 adult patients in Northern Ireland with serum creatinine > 150 µmol/l in 2001.
• Exclusion criteria included pre-existing nephrologist care and acute renal failure.
• Analysis of referral rates within 12 months post-initial elevated creatinine test.

Main Results:

• Only 6.5% of non-diabetic patients and 19% of diabetic patients were referred within 12 months.
• Younger age and diabetes mellitus were associated with higher referral likelihood.
• No significant difference in referral rates was observed between male and female patients.

Conclusions:

• Current referral practices for patients with elevated serum creatinine fall significantly below recommended levels.
• Diabetic patients and younger individuals are more likely to receive specialist referral, but overall rates remain suboptimal.
• Systemic improvements are needed to ensure timely nephrologist assessment for at-risk CKD populations.