Albuminuria testing and nephrology care among insured US adults with chronic kidney disease: a missed opportunity.
Albuminuria testing and nephrology care among insured US adults with chronic kidney disease: a missed opportunity.
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DOI：
10.1186/s12875-022-01910-9
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发表时间：
2022-11-24
期刊：
影响因子：
--
通讯作者：
Tuot DS
中科院分区：
文献类型：
--
作者：
Chu CD;Powe NR;Shlipak MG;Scherzer R;Tummalapalli SL;Estrella MM;Tuot DS
在慢性肾脏病（CKD）中，评估估计的肾小球滤过率（eGFR）和白蛋白尿对于分层风险和确定是否需要肾脏病转诊是必要的。肾脏疾病：改善CKD全球结局临床实践指南建议eGFR < 30 ml/min/1.73m2或尿白蛋白/肌酐比值≥ 300 mg/g的患者转诊至肾病科。使用商业保险或医疗保险优势覆盖的美国患者的国家索赔数据库，我们确定了在初级保健中积极随访的CKD患者。我们根据这些患者的CKD分期，使用eGFR和蛋白尿分类，检查了这些患者在1年内接受肾脏病治疗的情况。采用多变量logistic回归分析，根据CKD分类，调整年龄、性别、种族/民族、糖尿病、心力衰竭和冠状动脉疾病，检查接受肾病治疗的几率。在291，155例CKD患者中，55%符合指南推荐的转诊标准的患者曾看过肾病科医生。eGFR < 30（64%; 11，330/17738）的患者接受指南推荐的肾病治疗的比例高于UACR ≥300 mg/g（51%; 8789/17290）的患者。59%的人没有进行白蛋白尿检测。未进行白蛋白尿检测的患者接受推荐肾病治疗的调整后比值明显较低（eGFR < 30 ml/min/1.73 m2的aOR为0.47 [0.43，0.52]）。在按糖尿病状态分层的分析中观察到类似模式。只有一半的患者符合肾脏病转诊的实验室标准，由肾脏科医生。未充分利用白蛋白尿检测可能是识别肾衰竭风险升高的初级保健患者的障碍，这些患者可能需要肾脏科转诊。在线版本包含补充材料，可通过10.1186/s12875-022-01910-9获得。
In chronic kidney disease (CKD), assessment of both estimated glomerular filtration rate (eGFR) and albuminuria are necessary for stratifying risk and determining the need for nephrology referral. The Kidney Disease: Improving Global Outcomes clinical practice guidelines for CKD recommend nephrology referral for eGFR < 30 ml/min/1.73m2 or for urinary albumin/creatinine ratio ≥ 300 mg/g. Using a national claims database of US patients covered by commercial insurance or Medicare Advantage, we identified patients with CKD who were actively followed in primary care. We examined receipt of nephrology care within 1 year among these patients according to their stage of CKD, classified using eGFR and albuminuria categories. Multivariable logistic regression was used to examine odds of receiving nephrology care by CKD category, adjusting for age, sex, race/ethnicity, diabetes, heart failure, and coronary artery disease. Among 291,155 patients with CKD, 55% who met guideline-recommended referral criteria had seen a nephrologist. Receipt of guideline-recommended nephrology care was higher among those with eGFR < 30 (64%; 11,330/17738) compared with UACR ≥300 mg/g (51%; 8789/17290). 59% did not have albuminuria testing. Those patients without albuminuria testing had substantially lower adjusted odds of recommended nephrology care (aOR 0.47 [0.43, 0.52] for eGFR < 30 ml/min/1.73m2). Similar patterns were observed in analyses stratified by diabetes status. Only half of patients meeting laboratory criteria for nephrology referral were seen by a nephrologist. Underutilization of albuminuria testing may be a barrier to identifying primary care patients at elevated kidney failure risk who may warrant nephrology referral. The online version contains supplementary material available at 10.1186/s12875-022-01910-9.
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使用基于风险的分层对从初级保健到英国专业护理的慢性肾脏疾病患者转诊的影响。
影响因子：
6
作者：
Bhachu HK;Cockwell P;Subramanian A;Adderley NJ;Gokhale K;Fenton A;Kyte D;Nirantharakumar K;Calvert M
通讯作者：
Calvert M
影响因子：
39.2
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Sumida K;Nadkarni GN;Grams ME;Sang Y;Ballew SH;Coresh J;Matsushita K;Surapaneni A;Brunskill N;Chadban SJ;Chang AR;Cirillo M;Daratha KB;Gansevoort RT;Garg AX;Iacoviello L;Kayama T;Konta T;Kovesdy CP;Lash J;Lee BJ;Major RW;Metzger M;Miura K;Naimark DMJ;Nelson RG;Sawhney S;Stempniewicz N;Tang M;Townsend RR;Traynor JP;Valdivielso JM;Wetzels J;Polkinghorne KR;Heerspink HJL;Chronic Kidney Disease Prognosis Consortium
通讯作者：
Chronic Kidney Disease Prognosis Consortium
影响因子：
168.9
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Matsushita, Kunihiro;van der Velde, Marije;Astor, Brad C.;Woodward, Mark;Levey, Andrew S.;de Jong, Paul E.;Coresh, Josef;Gansevoort, Ron T.
通讯作者：
Gansevoort, Ron T.
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16.2
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影响因子：
158.5
作者：
Perkovic, V.;Jardine, M. J.;Bentley-Lewis, Rhonda
通讯作者：
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