von Samson-Himmelstjerna Friedrich A, Steiger Edgar, Kolbrink Benedikt, Wülfrath Hauke S, Czihal Thomas, Schmitt Roland, von Stillfried Dominik, Schulte Kevin
Department of Nephrology and Hypertension, University Hospital Schleswig-Holstein, Kiel, Germany.
Central Research Institute of Ambulatory Health Care in Germany, Berlin, Germany.
Lancet Reg Health Eur. 2024 Oct 31;47:101111. doi: 10.1016/j.lanepe.2024.101111. eCollection 2024 Dec.
Chronic kidney disease (CKD) is one of the most significant drivers of the global burden of disease and an increasing public health issue. Adequate monitoring and referral of high-risk patients to nephrologists are associated with improved management of CKD. We aimed to assess nephrology referral rates, monitoring of kidney function, and factors associated with failure to refer in Germany.
We retrospectively analyzed ambulatory claims data of 73,675,956 German patients who were covered by statutory health care in 2022, building a cohort of 1,301,122 patients who had at least two diagnoses of CKD stage 3-5 within the calendar year. In our analysis, we focused particularly on patients with CKD stage 4.
We identified 207,043 patients with CKD stage 4, of which 134,143/207,043 (64.8%) received nephrologist treatment in 2022. The median age of the cohort was 82 years. Failure to quantify proteinuria occurred in 61,991/72,900 (85.0%) non-referred patients compared to 51,382/134,143 (38.3%) referred patients. In a mixed logistic regression model, referral was less likely for women (odds ratio [OR] 0.72, 95% confidence interval [CI] 0.71-0.74), higher age (OR per year 0.97, CI 0.96-0.97), nursing home inhabitants (OR 0.63, CI 0.61-0.65), and those with certain comorbidities. Regional factors (deprivation, population density, nephrologist density) were not associated with referral.
A substantial proportion of patients with late-stage CKD are not receiving guideline-recommended kidney care in the German health care system, with disparities driven primarily by individual patient factors rather than geographical barriers.
This study was funded by the University Hospital Schleswig-Holstein and the Central Research Institute of Ambulatory Health Care in Germany.
慢性肾脏病（CKD）是全球疾病负担的最重要驱动因素之一，也是一个日益严重的公共卫生问题。对高危患者进行充分监测并将其转诊至肾病专家处，与改善CKD的管理相关。我们旨在评估德国的肾病转诊率、肾功能监测情况以及与未转诊相关的因素。
我们回顾性分析了2022年参加法定医疗保险的73675956名德国患者的门诊索赔数据，建立了一个队列，其中包括在该日历年内至少有两次CKD 3 - 5期诊断的1301122名患者。在我们的分析中，我们特别关注CKD 4期患者。
我们确定了207043名CKD 4期患者，其中134143/207043（64.8%）在2022年接受了肾病专家治疗。该队列的中位年龄为82岁。在未转诊的72900名患者中，61991/72900（85.0%）未对蛋白尿进行定量，而在转诊的134143名患者中，这一比例为51382/134143（38.3%）。在混合逻辑回归模型中，女性（优势比[OR] 0.72，95%置信区间[CI] 0.71 - 0.74）、年龄较大（每年OR 0.97，CI 0.96 - 0.97）、养老院居民（OR 0.63，CI 0.61 - 0.65）以及患有某些合并症的患者转诊的可能性较小。地区因素（贫困程度、人口密度、肾病专家密度）与转诊无关。
在德国医疗体系中，相当一部分晚期CKD患者未接受指南推荐的肾脏护理，差异主要由个体患者因素而非地理障碍导致。
本研究由石勒苏益格 - 荷尔斯泰因大学医院和德国门诊医疗中央研究所资助。
