Original InvestigationPathogenesis and Treatment of Kidney DiseaseImpact of Estimated GFR Reporting on Patients, Clinicians, and Health-Care Systems: A Systematic Review
Section snippets
Study Selection
We reviewed studies describing the effects of eGFR reporting according to a standardized protocol. We included studies irrespective of their study design that were published in full-text or abstract form in any language. We were interested in the following outcomes: (1) changes in referrals, visits, or consults seen by nephrologists; (2) changes in characteristics of referred patients; and (3) changes in prescription rates of ACE inhibitors and ARBs. We excluded editorials and review articles.
Data Sources and Search Strategy
Search Strategy Results
We screened 8,720 citations, of which 8,621 were excluded based on title and abstract screening. Ninety-nine citations were selected for full-text review. Of these, 46 were excluded because they were commentaries or letters, 30 were excluded because they did not assess the impact of eGFR reporting, and 1 was excluded because it reported solely laboratory testing changes after eGFR reporting. This left 22 studies that met our inclusion criteria. Of the 22 studies, 10 were published as journal
Discussion
Our results indicate that implementation of eGFR reporting is associated almost universally with an increase in patients with CKD, seen as a consult or referred to a nephrologist for further care. Temporally, these increases closely followed the introduction of eGFR reporting. The increases ranged from minimal changes to a dramatic 270% increase over pre–eGFR reporting period rates. Furthermore, the impact of eGFR reporting on these outcomes was greatest in elderly and female patients.
We
Acknowledgements
Support: Mr Kagoma received funding from the Summer Research Training Program at the Schulich School of Medicine & Dentistry at the University of Western Ontario. Dr Jain is supported by a Health Professionals Fellowship from the Canadian Institutes of Health Research and receives funding from the Ministry of Health. Dr Garg is supported by a Clinician Scientist Award from the Canadian Institutes of Health Research. Dr Patel is supported by National Institutes of Health grant K23 DK075929. The
References (47)
Reporting estimated GFR: a laboratory perspective
Am J Kidney Dis
(2008)- et al.
Identification and referral of patients with progressive CKD: a national study
Am J Kidney Dis
(2006) - et al.
Systematic review of the evidence underlying the association between mineral metabolism disturbances and risk of fracture and need for parathyroidectomy in CKD
Am J Kidney Dis
(2009) - et al.
The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration
J Clin Epidemiol
(2009) - et al.
Does reporting estimated glomerular filtration rate affect ordering of timed urine collections?
Am J Med Sci
(2009) - et al.
Reporting of estimated GFR in the primary care clinic
Am J Kidney Dis
(2007) - et al.
When laboratories report estimated glomerular filtration rates in addition to serum creatinines, nephrology consults increase
Kidney Int
(2009) - et al.
An economic evaluation of early versus late referral of patients with progressive renal insufficiency
Am J Kidney Dis
(2001) - et al.
Chronic kidney disease: issues and establishing programs and clinics for improved patient outcomes
Am J Kidney Dis
(2003) Estimating glomerular filtration rate (eGFR)Ontario Society of Clinical Chemists
Clinical practice guidelines—module 1: chronic kidney diseaseUK Renal Association
Implementation of the routine reporting of eGFR in Australia and New Zealand
Scand J Clin Lab Invest Suppl
Low rates of testing and diagnostic codes usage in a commercial clinical laboratory: evidence for lack of physician awareness of chronic kidney disease
J Am Soc Nephrol
eGFR: is it ready for early identification of CKD?
Clin J Am Soc Nephrol
Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization
N Engl J Med
Association of single measurements of dipstick proteinuria, estimated glomerular filtration rate, and hematocrit with 25-year incidence of end-stage renal disease in the multiple risk factor intervention trial
J Am Soc Nephrol
Angiotensin-converting enzyme inhibitors and progression of nondiabetic renal diseaseA meta-analysis of patient-level data
Ann Intern Med
The deadly risk of late referral
Nephrol Dial Transplant
Screening for CKD with eGFR: doubts and dangers
Clin J Am Soc Nephrol
Automated reporting of eGFR: a useful tool for identifying and managing kidney disease
Med J Aust
Automatic reporting of estimated glomerular filtration rate—jumping the gun?
Clin Chem
Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration
PLoS Med
The early impact of the United Kingdom Chronic Kidney Disease (CKD) guidelines on the number of new attendances at renal clinics
Scott Med J
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Originally published online December 13, 2010.