Most patients with lab evidence of kidney disease are not referred to nephrologists

Less than 20% of patients with laboratory evidence of kidney disease are referred for specialty care but most patients who are not referred have low predicted two-year risk of kidney failure

Kidney disease guidelines for nephrology referral are transitioning from recommending referral based on laboratory value thresholds to using risk of kidney failure to guide referrals, but the impact on healthcare systems is not known. Using data from the Veterans Health Administration, researchers estimated the potential volume of nephrology referrals based on laboratory data, the estimated risk of kidney failure, or a combination of both. In a study published in the American Journal of Kidney diseases, Vishal Duggal et al report that referral based on a two-year risk of kidney failure of 1% or higher would result in a similar number of referrals as current laboratory-based guidelines but would identify patients at higher median risk for kidney failure.

ARTICLE TITLE: Nephrology Referral Based on Laboratory Values, Kidney Failure Risk, or Both: A Study Using Veterans Affairs Health System Data

AUTHORS: Vishal Duggal, MD, Maria E. Montez-Rath, I-Chun Thomas, Mary K. Goldstein, and Manjula Kurella Tamura, MD, MPH

DOI: 10.1053/j.ajkd.2021.06.028