Risk-Based Triage for Nephrology Referrals Using the Kidney Failure Risk Equation

Area of Science:

• Nephrology
• Health Services Research
• Public Health Policy

Background:

• Routine reporting of estimated glomerular filtration rate (eGFR) has increased nephrology referrals and wait times in some areas.
• Managing increasing referral volumes is a challenge for nephrology services.

Purpose of the Study:

• To evaluate the effectiveness of the Kidney Failure Risk Equation (KFRE) in a triage process for new nephrology referrals.
• To assess the impact of a risk-based triage system on referral wait times and access to care for patients with chronic kidney disease (CKD) stages 3-5.

Main Methods:

• A quasi-experimental study was conducted in Manitoba, Canada, comparing pre- and post-triage periods (2011 vs. 2013).
• The Kidney Failure Risk Equation (KFRE) with a 3% 5-year risk cutoff was used for triage.
• Referrals with <3% risk were returned to primary care, while others were triaged based on urgency. Wait times and referral numbers were compared.

Main Results:

• Referral numbers increased from 68/month to 94/month post-triage.
• Wait times decreased significantly from a median of 230 days to 58 days.
• In the post-triage period, 35% of referrals were urgent, 31% nonurgent, and 34% were not booked.

Conclusions:

• The KFRE-based risk stratification is an effective health policy tool for managing nephrology referrals.
• This triage scheme improved wait times and access to care for high-risk patients.
• Further long-term follow-up is needed for low-risk patients.