R HONG1, S PIRABHAHAR1, K TURNER1, I.J KATZ1,2
1St George Hospital Renal Department, Kogarah, Australia, 2University of New South Wales, Sydney, Australia
Aim: Evaluate use of the Kidney Failure Risk Equation (KFRE) score for triaging new renal patient referrals to nephrologists.
Background: KFRE was developed and validated in global CKD populations to predict progression to end-stage kidney disease (ESKD). It is also used as a threshold for decision making e.g. nephrology follow-up, vascular access.
Methods: In January 2019, The St George Hospital Renal Department introduced a triage consultant for new referrals and a risk-based triage system was implemented based on the KFRE. A risk score of 3% at 5-years was the threshold for nephrologist follow-up. “Low-risk” patients could have follow-up at consultant discretion e.g. suspected glomerulonephritis, uncontrolled hypertension, severe proteinuria. The number of consults seen between pre-triage and post-triage periods was compared.
Results: In 2019 there were 25% less referrals compared to 2018 and 30% less than 2017. Compared to 2018, fewer patients had a low-risk KFRE at triage (46% vs. 48%) and fewer low-risk patients had clinic follow-up (50% vs. 52%). Subgroup analysis of low-risk patients remaining in clinic showed more patients (86% vs. 60%) had alternative reasons for follow-up (i.e. eGFR<30ml/min, moderate proteinuria, or uncontrolled hypertension).
Conclusions: Implementing a triage system has reduced patient numbers in outpatient clinics. The KFRE score as a risk-based triage system has been an effective tool leading to reduced low-risk patient follow-up. Limitations include inability to calculate KFRE score for large numbers of referrals at triage (28% in 2018, 36% in 2019). This reflects referrals missing a urine albumin-creatinine ratio at referral. Pre-specified criteria delineating patients requiring follow-up despite low-risk KFRE score may be useful. This study supports similar findings of KFRE score reducing referrals to renal outpatient clinics.
Regina is a Basic Physician Trainee at St George Hospital with a passion for renal medicine and palliative care. Research interests include progression and complications of chronic kidney disease, renal supportive care as well as health policy, planning and management.