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Original Contribution
March 24 2010

Nephrology Visits and Health Care Resource Use Before and After Reporting Estimated Glomerular Filtration Rate

Author Affiliations

Author Affiliations: Departments of Medicine (Drs Hemmelgarn, Manns, James, Quinn, Ravani, and Culleton and Mr Zhang) and Community Health Sciences (Drs Hemmelgarn, Manns, James, and Ravani), University of Calgary, and Calgary Laboratory Services (Dr Krause), Calgary, Alberta, Canada; Department of Medicine, University of Alberta, Edmonton, Canada (Drs Klarenbach and Tonelli); Diagnostic Services of Manitoba, Winnipeg, Canada (Dr Thorlacius); and Department of Medicine, University of Western Ontario, London, Canada (Dr Jain).

JAMA. 2010;303(12):1151-1158. doi:10.1001/jama.2010.303

Context Laboratory reporting of estimated glomerular filtration rate (GFR) has been widely implemented, with limited evaluation.

Objective To examine trends in nephrologist visits and health care resource use before and after estimated GFR reporting.

Design, Setting, and Patients Community-based cohort study (N = 1 135 968) with time-series analysis. Participants were identified from a laboratory registry in Alberta, Canada, and followed up from May 15, 2003, to March 14, 2007 (with estimated GFR reporting implemented October 15, 2004).

Main Outcome Measure Nephrologist visits and patient management.

Results Following estimated GFR reporting, the rate of first outpatient visits to a nephrologist for patients with chronic kidney disease (CKD; estimated GFR <60 mL/min/1.73 m2) increased by 17.5 (95% confidence interval [CI], 16.5-18.6) visits per 10 000 CKD patients per month, corresponding to a relative increase from baseline of 68.4% (95% CI, 65.7%-71.2%). There was no association between estimated GFR reporting and rate of first nephrologist visit among patients without CKD. Among patients with an estimated GFR of less than 30 mL/min/1.73 m2, the rate of first nephrologist visits increased by 134.4 (95% CI, 60.0-208.7) visits per 10 000 patients per month. This increase was predominantly seen in women, patients aged 46 to 65 years as well as those aged 86 years or older, and those with hypertension, diabetes, and comorbidity. Reporting of estimated GFR was not associated with increased rates of internal medicine or general practitioner visits or increased use of angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers among patients with CKD and proteinuria or the subgroup limited to patients with diabetes.

Conclusions Reporting of estimated GFR was associated with an increase in first nephrologist visits, particularly among patients with more severe kidney dysfunction, women, middle-aged and very elderly patients, and those with comorbidities. Any effect on outcomes remains to be shown.