Frequency of CKD Patient Referrals to Nephrology Clinics Using the Kidney Failure Risk Equation at Kaiser Permanente Northern California

Background: Early detection of chronic kidney disease (CKD) is a fundamental goal in caring for patients with kidney disease. Timely implementation of a CKD care plan for patients, and regular follow up with a nephrology care team, can help delay the onset of end-stage kidney disease (ESKD). Referrals to a nephrologist for CKD care are often placed by primary care providers (PCPs), prompted by certain lab abnormalities. The Kidney Disease: Improving Global Outcomes (KDIGO) guidelines recommend that patients with CKD stage 3B through 5 be referred to a nephrologist. Although early education about healthy lifestyle habits and ESKD treatment options has been shown to improve patient outcomes, a subset of patients continues to have delayed detection of CKD. The kidney failure risk equation (KFRE), which is a four-variable risk equation, is an added tool to help identify patients at risk for CKD progression. In 2021, the KFRE was incorporated into PCP referral guidelines at Kaiser Permanente Northern California (KPNC). This study aims to evaluate the frequency of CKD referrals in the three years before and after the incorporation of KFRE. Methods: A KPNC statistical analyst will help collect data using the following inclusion criteria: patients ≥18 years old, with at least one estimated Glomerular Filtration Rate (eGFR) < 45 ml/min/1.73m2 prior to the initial referral to KPNC Nephrologist, and at least two eGFR < 60 ml/min/1.73m2 three months apart in the 3 years prior to referral. Data will be collected over a 6-year period, 3 years before and after KFRE incorporation. Statistical analysis will be performed by the analyst. Results: This is an ongoing study, currently in the data collection phase. Projected completion of data collection and evaluation will be by August/September 2024. Conclusion: There is wide variability in the referral of patients with CKD to a nephrologist. The KFRE is an important tool that can help identify patients at higher risk for progression of CKD. By incorporating the KFRE into PCP referral guidelines at KPNC, the number of appropriate CKD referrals to nephrology was enhanced. These patients can then have access to available treatments to help slow their progression to ESKD.