Koraishy Farrukh M, Hooks-Anderson Denise, Salas Joanne, Scherrer Jeffrey F
Division of Nephrology, Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, MO, USA.
Renal Section, Department of Medicine, John Cochran VA medical Center, St. Louis, MO, USA.
Fam Pract. 2017 Aug 1;34(4):416-422. doi: 10.1093/fampra/cmx012.
Late nephrology referral is associated with adverse outcomes especially among minorities. Research on the association of the rate of chronic kidney disease (CKD) progression with nephrology referral in white versus black patients is lacking.
Compute the odds of nephrology referral in primary care and their associations with race and the rate of CKD progression.
Electronic health record data were obtained from 2170 patients in primary care clinics in the Saint Louis metropolitan area with at least two estimated glomerular filtration rate (eGFR) values over a 7-year observation period. Fast CKD progression was defined as a decline in eGFR of ≥5 ml/min/1.73 m2/year. Logistic regression models were computed to measure the associations between eGFR progression, race and nephrology referral before and after adjusting for potential confounding factors.
Nephrology referrals were significantly more prevalent among those with fast compared to slow progression (5.6 versus 2.0%, P < 0.0001), however, a majority of fast progressors were not referred. Fast CKD progression and black race were associated with increased odds of nephrology referral (OR = 2.74; 95% CI: 1.60-4.72 and OR = 2.42; 95% CI: 1.28-4.56, respectively). The interaction of race and eGFR progression in nephrology referral was found to be non-significant.
Nephrology referrals are more common in fast CKD progression, but referrals are underutilized. Nephrology referral is more common among blacks but its' association with rate of decline does not differ by race. Further studies are required to investigate the benefit of early referral of patients at risk of fast CKD progression.
晚期肾病转诊与不良后果相关，尤其是在少数族裔中。目前缺乏关于白人患者与黑人患者慢性肾病（CKD）进展速度与肾病转诊之间关联的研究。
计算初级保健中肾病转诊的几率及其与种族和CKD进展速度的关联。
从圣路易斯都会区初级保健诊所的2170名患者中获取电子健康记录数据，这些患者在7年观察期内至少有两个估算肾小球滤过率（eGFR）值。快速CKD进展定义为eGFR下降≥5 ml/min/1.73 m²/年。计算逻辑回归模型以测量在调整潜在混杂因素前后eGFR进展、种族与肾病转诊之间的关联。
与进展缓慢的患者相比，快速进展患者中的肾病转诊明显更为普遍（5.6%对2.0%，P < 0.0001），然而，大多数快速进展者未被转诊。快速CKD进展和黑人种族与肾病转诊几率增加相关（OR分别为2.74；95% CI：1.60 - 4.72和OR为2.42；95% CI：1.28 - 4.56）。发现种族与eGFR进展在肾病转诊中的相互作用不显著。
肾病转诊在快速CKD进展中更为常见，但转诊未得到充分利用。肾病转诊在黑人中更为常见，但其与下降速度的关联在种族间并无差异。需要进一步研究以调查对有快速CKD进展风险的患者进行早期转诊的益处。
