Original Investigation
Pathogenesis and Treatment of Kidney Disease
Impact of Estimated GFR Reporting on Patients, Clinicians, and Health-Care Systems: A Systematic Review

https://doi.org/10.1053/j.ajkd.2010.08.029Get rights and content

Background

Many laboratories now report estimated glomerular filtration rate (eGFR) when a serum creatinine measurement is ordered. A summary of the impact of eGFR reporting in health care systems around the world for which it has been adopted is lacking.

Study Design

Systematic review of MEDLINE, EMBASE, other major databases, and conference proceedings of major nephrology meetings.

Setting & Population

Any health care system in which eGFR reporting was introduced.

Selection Criteria for Studies

Published studies or abstracts reporting patient, clinician, or health system outcomes of eGFR reporting.

Intervention

eGFR reporting.

Outcomes

Volume of referrals or consults seen by nephrologists, changes in characteristics of patients who were seen, and prescription rates of kidney-related medications.

Results

22 studies (10 full text and 12 conference abstracts) were identified in 2004-2010 from 5 countries. Nephrologist referrals and consultations increased after eGFR reporting, ranging from 13%-270%. The greatest increases in referrals were seen for the elderly, females, and those with stage 3 or higher chronic kidney disease (eGFR <60 mL/min/1.73 m2). Change in renin-angiotensin-aldosterone system–blocking drug use ranged from increases of 0%-6%.

Limitations

Studies were highly variable in definition of outcomes. Reports were not available for many health care systems in which eGFR reporting was implemented.

Conclusions

eGFR reporting has been associated with greater identification of patients with decreased kidney function in most health care systems that have reported its impact.

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

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    Originally published online December 13, 2010.

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