Impact of Using Risk-Based Stratification on Referral of Patients With Chronic Kidney Disease From Primary Care to Specialist Care in the United Kingdom.
Impact of Using Risk-Based Stratification on Referral of Patients With Chronic Kidney Disease From Primary Care to Specialist Care in the United Kingdom.
复制标题
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。
DOI：
10.1016/j.ekir.2021.05.031
复制
发表时间：
2021-08
影响因子：
6
通讯作者：
Calvert M
中科院分区：
文献类型：
--
作者：
Bhachu HK;Cockwell P;Subramanian A;Adderley NJ;Gokhale K;Fenton A;Kyte D;Nirantharakumar K;Calvert M
用于预测终末期肾病(ESRD)风险的外部验证肾功能衰竭风险方程(KFRE)已被开发出来，但其在人群中对慢性肾脏病(CKD)患者从初级肾病护理到专科肾病护理的转诊的潜在影响尚不清楚。对在健康改善网络数据库中登记的联合王国初级保健个人进行了一项基于人口的横断面研究。2016年1月1日至2017年3月31日期间，美国国家健康与护理卓越研究所(NICE)2014年CKD指南与4变量KFRE指南相比，被设置为5年ESRD风险为3%的KFRE应用于CKD 3-5期患者。总体而言，107,962名CKD分期为3-5的成人患者中，有39,476人(36.6%)的尿白蛋白/肌酐比值(ACR)可用，并进入初步分析。其中，7,566例(19.2%)患者符合NICE转诊标准，其中2,386例(31.5%)≤为终末期肾病的3-5年风险。此外，8663名患者(21.9%)有3%的5年终末期肾病风险，其中3483名患者(40.2%)不符合NICE标准；这占原始人口的8.8%。通过使用KFRE阈值而不是NICE标准进行转诊，5869名患者(占主要分析人群的14.9%)将在初级和专科护理之间重新分配。对丢失的ACR测量进行了估算分析，并显示了类似的结果。基于风险的转诊方法将导致患者在初级护理和专科肾病护理之间进行实质性重新分配，而符合条件的人数仅略有增加，确保确定那些进展风险较高的患者。
The externally validated Kidney Failure Risk Equation (KFRE) for predicting risk of end-stage renal disease (ESRD) has been developed, but its potential impact in a population on referrals for patients with chronic kidney disease (CKD) from primary to specialty nephrology care is not known. A cross-sectional population-based study of individuals in United Kingdom primary care registered in The Health Improvement Network database was conducted. National Institute of Health and Care Excellence (NICE) 2014 CKD guidelines versus the 4-variable KFRE set at a >3% risk of ESRD at 5 years were applied to patients identified with CKD stage 3-5 between January 1, 2016, and March 31, 2017. In all, 39,476 (36.6%) of 107,962 adults with CKD stage 3-5 had a urine albumin:creatinine ratio (ACR) available and entered into the primary analysis. Of that, 7566 (19.2%) patients fulfilled NICE criteria for referral, 2386 (31.5%) of whom had a ≤3% 5-year risk of ESRD. Also 8663 (21.9%) patients had a >3% 5-year risk of ESRD, 3483 (40.2%) of whom did not fulfill NICE criteria; this represents 8.8% of the primary population. By using the KFRE threshold rather than NICE criteria for referral, 5869 patients (14.9% of the primary analysis population) would have been reallocated between primary and specialist care. Imputational analysis was used for missing ACR measurements and showed similar results. A risk-based referral approach would lead to a substantial reallocation of patients between primary care and specialist nephrology care with only a small increase in numbers eligible, ensuring those at higher risk of progression are identified.
登录
查看更多内容
DOI：
10.1136/bmj.f324
发表时间：
2013-01-29
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Nitsch D;Grams M;Sang Y;Black C;Cirillo M;Djurdjev O;Iseki K;Jassal SK;Kimm H;Kronenberg F;Oien CM;Levey AS;Levin A;Woodward M;Hemmelgarn BR;Chronic Kidney Disease Prognosis Consortium
通讯作者：
Chronic Kidney Disease Prognosis Consortium
影响因子：
15.8
作者：
Major, Rupert W.;Shepherd, David;Brunskill, Nigel J.
通讯作者：
Brunskill, Nigel J.
影响因子：
158.5
作者：
Perkovic, V.;Jardine, M. J.;Bentley-Lewis, Rhonda
通讯作者：
Bentley-Lewis, Rhonda
DOI：
10.2215/cjn.08110715
发表时间：
2016-04-01
影响因子：
9.8
作者：
Lennartz, Claudia S.;Pickering, John William;Heine, Gunnar H.
通讯作者：
Heine, Gunnar H.
影响因子：
120.7
作者：
Hallan, Stein I.;Matsushita, Kunihiro;Sang, Yingying;Mahmoodi, Bakhtawar K.;Black, Corri;Ishani, Areef;Kleefstra, Nanne;Naimark, David;Roderick, Paul;Tonelli, Marcello;Wetzels, Jack F. M.;Astor, Brad C.;Gansevoort, Ron T.;Levin, Adeera;Wen, Chi-Pang;Coresh, Josef
通讯作者：
Coresh, Josef