After a 3-month transition period following estimated GFR reporting, the rate of first outpatient visits to a nephrologist for patients with CKD (estimated GFR less than 60 mL/min/1.73 m2) increased significantly, corresponding to a relative increase from the beginning of the study of 68 percent. This rate of increase was even greater for participants with estimated GFR of less than 30 mL/min/1.73 m2, the group for whom current clinical practice guidelines emphasize the value of timely nephrological referral. For these patients, women experienced a greater increase in the rate of first visits to a nephrologist, while there was no increase for men, and the increase was predominantly seen in patients ages 46 to 65 and those 86 years or older, as well as those with hypertension, diabetes, and other co-existing illnesses.

Among patients without CKD, there was no association between estimated GFR reporting and rate of first outpatient nephrologist visits. The rate of all outpatient nephrologist visits for patients with CKD following estimated GFR reporting (including visits among individuals with and without prior nephrologist visits) also increased significantly.

"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," the authors write. However, referral of participants at increased risk of late detection of CKD and who may benefit most from specialized care, such as patients with more severe kidney dysfunction, older or female patients, did increase significantly.

"The association with estimated GFR reporting and long-term patient outcomes, as well as economic consequences, remains to be determined."

SOURCE JAMA