Can increased vigilance for chronic kidney disease in hospitalised patients decrease late referral and improve...

Area of Science:

• Nephrology
• Public Health
• Internal Medicine

Background:

• Poor vigilance for renal insufficiency is linked to delayed referrals, increased morbidity, and mortality.
• Chronic kidney disease (CKD) management often suffers from insufficient patient and physician awareness.
• Early detection and management are crucial for improving outcomes in patients with CKD.

Purpose of the Study:

• To determine if increased vigilance for CKD improves referral rates and follow-up by nephrologists.
• To assess if enhanced CKD awareness is associated with better patient outcomes.
• To evaluate the impact of simple interventions on CKD management.

Main Methods:

• Patients hospitalized with an estimated glomerular filtration rate (eGFR) < 45 ml/min/1.73 m² were enrolled.
• Patients' awareness of CKD was assessed through interviews.
• Interventions involved informing patients and their general practitioners about CKD, followed by monitoring referral and clinical outcomes.

Main Results:

• Only 65% of patients with proven CKD were aware of their condition, and 41% were in regular nephrological follow-up.
• Following the intervention, CKD follow-up increased significantly from 41% to 71% (p=0.002).
• Quicker referral and nephrological follow-up were associated with significantly lower rates of dialysis and mortality (p=0.015 and p=0.006, respectively).

Conclusions:

• Vigilance for CKD is generally poor, highlighting a significant gap in current healthcare practices.
• Simple interventions can effectively increase vigilance for CKD, leading to quicker nephrologist referrals and improved follow-up.
• Enhanced CKD awareness and timely nephrological care are associated with better patient outcomes, including reduced morbidity and mortality.