Estimated GFR reporting influences recommendations for dialysis initiation.

Area of Science:

• Nephrology
• Clinical Medicine
• Medical Informatics

Background:

• Automated reporting of estimated glomerular filtration rate (eGFR) alongside serum creatinine is increasingly prevalent in clinical practice.
• The impact of this automated reporting on clinical decision-making, specifically for dialysis initiation, requires investigation.

Purpose of the Study:

• To determine if the reporting of eGFR influences nephrologists' recommendations for initiating dialysis.
• To quantify the effect of eGFR reporting on dialysis recommendations.

Main Methods:

• A survey was distributed to nephrologists in four countries, presenting clinical vignettes.
• Respondents were randomized to receive vignettes with either serum creatinine alone or serum creatinine with eGFR.
• Likelihood of recommending dialysis initiation was assessed using an 8-point Likert scale.

Main Results:

• Analysis of 822 responses revealed that eGFR reporting increased the predicted likelihood of recommending dialysis by 0.55 points (95% CI, 0.33-0.76).
• This effect was more pronounced for eGFRs greater than 5 ml/min per 1.73 m².
• Physicians with 13 or more years of practice were more influenced by eGFR reporting.

Conclusions:

• eGFR reporting has a modest but significant impact on the recommendation for dialysis initiation.
• Nephrologists should be aware of the potential influence of eGFR reporting when assessing patients with severe chronic kidney disease.