Impact of estimated GFR reporting on patients, clinicians, and health-care systems: a systematic review.

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 m(2)). 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.

Duke Scholars

Author Uptal Dinesh Patel Medicine, Nephrology