Related Experiment Video
Updated: Mar 26, 2026
Author Spotlight: Developing a Bedside Protocol for Kidney and Genitourinary Ultrasonography
Published on: June 21, 2024
Chronic kidney disease referral practices among non-nephrology specialists: A single-centre experience
Jesmar Buttigieg1, Liam Mercieca2, Arielle Saliba2
1Nephrology Department, Mater Dei Hospital, Msida, Malta.
Insights
Early referral to nephrology teams (NT) is crucial for chronic kidney disease (CKD) patients. This study found that males, younger patients, and those with advanced CKD (stage 4+5) were more likely to be referred, but overall referral and urine test utilization remain low.
Area of Science:
- Nephrology
- Public Health
- Clinical Medicine
Background:
- Early referral of chronic kidney disease (CKD) patients to nephrology teams (NT) is vital for managing disease progression and planning renal replacement therapy (RRT).
- Late referral remains a significant challenge in CKD patient management.
- Timely intervention can delay the decline of kidney function.
Purpose of the Study:
- To investigate referral rates of hospitalized CKD patients to NT.
- To identify predictors of non-referral to NT.
- To assess the utilization of urine investigations post-discharge for CKD patients.
Main Methods:
- Retrospective analysis of 388 hospitalized CKD patients.
- Examination of referral patterns based on CKD stage, age, sex, and comorbidities.
- Analysis of urine investigation follow-up rates and their predictors.
Main Results:
- Referral rates upon discharge were 5.6% (CKD3A), 11.4% (CKD3B), and 16.4% (CKD4+5).
- Older age was associated with decreased referral odds (OR: 0.95).
- Males (OR: 2.31) and patients with CKD stage 4+5 (OR: 3.99) showed higher referral likelihood.
- Urine investigation follow-up was low (28.8%-50.7%) but higher in advanced CKD, diabetes, and those referred to NT.
- Only 16.4% of patients with eGFR <30mL/min/1.73m² were referred to NT.
Conclusions:
- Referral rates are highest among males, younger individuals, and those with advanced CKD (stage 4+5).
- Urine tests are underutilized in CKD patient follow-up.
- A significant minority of patients with advanced CKD receive timely nephrology team referral.
Background:
Early referral of CKD patients to nephrology teams (NT) is vital to identify patients most likely to progress, delay decline of excretory function, and provide planned RRT. Unfortunately, many are still being referred late.
Methods:
We conducted a retrospective analysis to investigate referral rates, predictors of non-referral, and performed urine investigations in hospitalised CKD patients.
Results:
Out of 388 patients studied, 5.6%, 11.4%, and 16.4% in CKD3A, 3B, and 4+5, respectively, were referred to an NT upon discharge (CKD3A vs. CKD4+5, p=0.016). For every additional year of age, the odds of being referred decreased by 5% (OR: 0.95, CI: 0.92-0.98, p=0.003). Patients were more likely to be referred to an NT if they were males (OR: 2.31, CI: 1.09-4.90, p=0.029) and having reached CKD 4+5 (OR: 3.99, CI: 1.58-10.10, p=0.003). Only 28.8%, 43.9%, and 50.7% of patients with CKD3A, 3B, and 4+5 were followed up with urine investigations after discharge (p=0.001). CKD stage 3B (OR: 3.54, CI: 1.23-10.19, p=0.019), CKD stage 4+5 (OR: 6.06, CI: 1.69-21.67, p=0.006), DM (OR: 6.28, CI: 2.38-16.58, p<0.0001), and having been referred to a NT (OR: 20.95, CI: 3.54-123.92, p=0.001) were independent predictors for having urine investigations.
Conclusion:
The highest rate of referral was achieved in males, younger age group, and those who have reached CKD stage 4+5. Urine tests remain largely underutilised and only a minority (16.4%) of patients with an eGFR <30mL/min/1.73m(2) were referred to a NT.
Related Concept Videos
01:28Chronic Kidney Disease III: Interprofessional Care
01:25Chronic Kidney Disease I: Introduction
01:30Acute Kidney Injury IV: Diagnostic Studies and Prevention
01:28Kidney Transplant I: Introduction
01:20Acute Kidney Injury V: Interprofessional Care
01:16Kidney Transplant III: Nursing Management