MO527REFERRAL CRITERIA TO NEPHROLOGY AND MATCHING DEGREE WITH THE CONSENSUS DOCUMENT FOR CHRONIC KIDNEY DISEASE DETECTION AND MANAGEMENT
Authors: Ferrer García Guillermo , Herráez García Lorena , Castro Fernández Maria Paz , Moral Berrio Esperanza , Olazo Gutierrez Eliana , Sidel Tambo Diego , Piccone Saponara Luis Guillermo , Sanchez Escudero Patricia , Vozmediano Poyatos Carmen , Carreño Parrilla Agustín 
Published: May 2021

Abstract

Background and Aims
Consensus document of the Spanish Society of Nephrology and many Primary Care (PC) related societies for chronic kidney disease (CKD) detection and management provides to the PC doctor referral criteria (RC) to nephrology clinic. The aim of the study is to describe the referrals to our center nephrology clinic and evaluate the influencing factors for RC adequacy.

Method
Retrospective observational study. We included the referred patients to our nephrology clinic from October 2019 to May 2020. We recollected demographic variables, as well as comorbidity, renal function, RC adequacy and follow-up. Categorical variables are expressed as percentages and compared using Chi2 test. Quantitative variables are expressed as mean ± standard deviation and compared using t-student test. Cox regression was performed to determine independent predictors for RC adequacy. Statistical significance for a value of p&lt; 0,05 or CI 95%. Statistical analysis was performed with SPSS 25.0.

Results
238 patients, 55.5% male. Average age 63 ± 17 years, being 34% older than 75 years. 67.6% had at least 3 cardiovascular risk factors. 85.3% were referred from PC with 57.1% of them from a rural center. There was adequation to the RC on 55%. The most frequent RC was CKD progression (37.4%). Mean serum creatinine at the time of referring was 1.91 ± 0.59 mg/dl with a glomerular filtration rate 34 ± 11 ml/min/1.73m2 and 329.43 ± 992.01 mg/g or mg/24h of albuminuria. From the 45% of those who did not had RC adequacy 51.4% had CKD III stage and 21.5% had false refractory hypertension (controlled or under-treated). Mean time of follow-up was 5 ± 1.7 months. RC adequacy was related with being referred from PC (59.6% vs 28.6% p=0.001), smoking (65.9% vs 49% p=0.012), time of referring creatinine (1.54 ± 0.86 vs 1.18 ± 0.39 p=0.001) and albuminuria (43406 ± 1009.7 vs 136.13 ± 637.16 p=0.019) and end of follow-up albuminuria (265.84 ± 516.82 vs 81.67 ± 250.7 p=0.007). RC adequacy was associated with receiving follow-up on nephrology clinic (80.2% vs 19.8% p=0.001). Logistic regression showed that being referred from PC (OR 3.64 IC 95% 1.03-12.8 p=0.044) and a worse renal function at the referring (OR 2.49 IC 95% 1.19-5.24 p=0.015) were associated with RC adequacy.

Conclusion
The experience in our center shows that there is not an adequacy on the current RC from the Spanish Society of Nephrology in almost half of the patients. That proportion decreases when patients are referred from PC close to 40%. CKD progression is the main reason for referral with most of patients being elderly and with a high cardiovascular risk. The need for greater dissemination of RC can be inferred from the significant number of inappropriate referrals, encouraging us to propose their review.