In Alberta, implementation of estimated glomerular filtration rate (eGFR) reporting by laboratories has been followed by an increase in initial visits to nephrologists for chronic kidney disease (CKD), according to a study in the Journal of the American Medical Association.
Alberta laboratories began reporting eGFR in 2004. A time-series analysis included more than 1.1 million adult outpatients who had at least one outpatient serum creatinine measurement, with follow-up from 2003 to 2007. Changes in the rate of outpatient visits to a nephrologist were assessed, along with use of health care resources and drugs commonly used to treat CKD (eGFR less than 60 mL/min/1.73 m2).
After implementation of eGFR reporting, the rate of initial outpatient visits to a nephrologist for patients with CKD increased by 17.5 visits per 10,000 CKD patients per month—a relative increase of 68 percent. Among patients without CKD, the rate of nephrologist visits was unchanged.
When CKD was defined as an eGFR of less than 30 mL/min/1.73 m2, the rate increased by 134.4 visits per 10,000 patients per month. Most of the increase occurred in women, patients aged 46 to 65 years or 86 years and older, patients with hypertension and diabetes, and those with comorbidity.
The increase in physician visits was specific to nephrologists—there was no change in visits to internists or general practitioners. Use of angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers did not increase among patients with CKD and proteinuria, including those with diabetes.
Laboratory reporting of eGFR might enhance early recognition and treatment of eGFR. However, it also has the potential for unintended negative effects. Automated eGFR reporting has been widely implemented, despite a lack of evidence.
Reporting of eGFR has led to substantial increases in the rate of initial nephrology visits by patients with CKD in Alberta, particularly those with more severe kidney dysfunction. Further research is needed to determine the effects of eGFR reporting on patient outcomes and on health care costs [Hemmelgarn BR, et al. Nephrology visits and health care resource use before and after reporting estimated glomerular filtration rate. JAMA 2010; 303:1151–1158].
