Gaps in Nephrology Referral Care Utilization in Patients at High-Risk of Progression to Kidney Failure

Early nephrology specialty care slows progression of chronic kidney disease (CKD) to end-stage renal disease (ESRD). However, identifying which patients are expected to progress to end-stage disease has been historically challenging to predict. With a limited supply of nephrologists, optimizing nephrology referral is essential for improving patient outcomes. The Kidney Failure Risk Equation (KFRE) provides an accurate metric to identify patients who are at high risk of progression to kidney failure. In this study, we utilize the KFRE to perform a retrospective analysis in a local health network to identify rates of nephrology referral for CKD patients stratified by risk of kidney failure progression. We found a nephrology referral gap in CKD patients at higher risk of progression and an underutilization of albuminuria testing in CKD, suggesting opportunities to improve outcomes by 1) proactively targeting high-risk patients using EHR-based informatics strategies and 2) increasing albuminuria testing as a screening tool.