Death and Dialysis Following Discharge From Chronic Kidney Disease Clinic: A Retrospective Cohort Study

Multidisciplinary care is recommended for patients with advanced chronic kidney disease (CKD). A formalized, risk-based approach to CKD management is being adopted in some jurisdictions. In Ontario, Canada, the eligibility criteria for multidisciplinary CKD care funding were revised between 2016 and 2018 to a 2 year risk of kidney replacement therapy (KRT) greater than 10% calculated by the 4-variable Kidney Failure Risk Equation (KFRE). Implementation of the risk-based approach has led to the discharge of prevalent CKD patients.

The primary objective of this study was to determine the frequency of occurrence of death and KRT initiation in patients discharged from CKD clinic.

Retrospective cohort study.

Single center multidisciplinary CKD clinic in Ontario, Canada.

Four hundred and twenty five patients seen at least once in 2013 at the multidisciplinary CKD clinic.

Outcomes included discharge status, death, re-referral and KRT initiation. Reasons for discharge were recorded.

Outcomes were extracted from available electronic medical records and the provincial death registry between the patient's initial clinic visit in 2013 and January 1, 2020. KFRE-2 scores were calculated using the 4-variable KFRE equation. The hazard rates of death and KRT after discharge due to stable eGFR/low KFRE were compared to patients who remained in the clinic.

Of the 425 CKD patients, 69 (16%) and 19 (4%) were discharged to primary care and general nephrology, respectively. Of those discharged, 7 (8%) were re-referred to nephrology or CKD clinic, while only 2 (2%) discharged patients required subsequent KRT. The hazard of mortality was reduced after discharge from the clinic due to stable eGFR/low KFRE (adjusted HR = 0.45 [95% CI, 0.25-0.78, P = .005]).

Single center, observational retrospective study design and unknown kidney function over time post discharge for most patients.

Discharge of low risk patients from multidisciplinary CKD clinic appears feasible and safe, with fewer than 1 in 40 discharged patients subsequently initiated on KRT over the following 7 years.