ArticleKidney international reports2021
Impact of Using Risk-Based Stratification on Referral of Patients With Chronic Kidney Disease From Primary Care to Specialist Care in the United Kingdom.
Article in Kidney international reports, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
23 citing papers in PubMed, 1 synthesis or guideline pooled it, 42 citations in OpenAlex.
- Pooled it
- Article
- Timely AVF creation in late-referral hemodialysis patients, a two-cohort study: Too late to plan, not too late to act.The journal of vascular access · 2026Article
- Risk-based referral model to nephrologist specialist care in Stockholm.Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association · 2025Observational
- Awareness and management of stage 3 chronic kidney disease among primary care practitioners in Italy: a nation-wide observational study.Journal of nephrology · 2025Observational
- Risk Stratification for CKD Progression in Primary Care.Kidney international reports · 2025Article
- When impact trials are not feasible: alternatives to study the impact of prediction models on clinical practice.Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association · 2024Article
- Primary and specialist care interaction and referral patterns for individuals with chronic kidney disease: a narrative review.BMC nephrology · 2024Review
- External validation of the KFRE and Grams prediction models for kidney failure and death in a Spanish cohort of patients with advanced chronic kidney disease.Journal of nephrology · 2024Article
- Recalibrating the kidney failure risk equation for a Mediterranean European population: reducing age and sex inequality.Frontiers in medicine · 2024Article
- Clinical Decision Support Tools in the Electronic Medical Record.Kidney international reports · 2024Review
- Implementation of the Kidney Failure Risk Equation in a United States Nephrology Clinic.Kidney international reports · 2023Article
- Utility of the Kidney Failure Risk Equation and Estimated GFR for Estimating Time to Kidney Failure in Advanced CKD.American journal of kidney diseases : the official journal of the National Kidney Foundation · 2023Article
- Implementing a Formalized Risk-Based Approach to Determine Candidacy for Multidisciplinary CKD Care: A Descriptive Cohort Study.Canadian journal of kidney health and disease · 2023Article
- Age-adapted eGFR thresholds underestimate the risks beyond kidney failure associated with CKD in older populations.Journal of the American Geriatrics Society · 2022Article
- Albuminuria testing and nephrology care among insured US adults with chronic kidney disease: a missed opportunity.BMC primary care · 2022Article
- Risk-based versus GFR threshold criteria for nephrology referral in chronic kidney disease.Clinical kidney journal · 2022Review
- Analysis of Specialty Nephrology Care Among Patients With Chronic Kidney Disease and High Risk of Disease Progression.JAMA network open · 2022Article
- Referral criteria for chronic kidney disease: implications for disease management and healthcare expenditure-analysis of a population-based sample.BMC nephrology · 2022Article
- Death and Dialysis Following Discharge From Chronic Kidney Disease Clinic: A Retrospective Cohort Study.Canadian journal of kidney health and disease · 2022Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
9 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionThe externally validated Kidney Failure Risk Equation (KFRE) for predicting risk of end-stage renal disease (ESRD) has been developed, but its potential impact in a population on referrals for patients with chronic kidney disease (CKD) from primary to specialty nephrology care is not known.
methodsA cross-sectional population-based study of individuals in United Kingdom primary care registered in The Health Improvement Network database was conducted. National Institute of Health and Care Excellence (NICE) 2014 CKD guidelines
resultsIn all, 39,476 (36.6%) of 107,962 adults with CKD stage 3-5 had a urine albumin:creatinine ratio (ACR) available and entered into the primary analysis. Of that, 7566 (19.2%) patients fulfilled NICE criteria for referral, 2386 (31.5%) of whom had a ≤3% 5-year risk of ESRD. Also 8663 (21.9%) patients had a >3% 5-year risk of ESRD, 3483 (40.2%) of whom did not fulfill NICE criteria; this represents 8.8% of the primary population. By using the KFRE threshold rather than NICE criteria for referral, 5869 patients (14.9% of the primary analysis population) would have been reallocated between primary and specialist care. Imputational analysis was used for missing ACR measurements and showed similar results.
conclusionsA risk-based referral approach would lead to a substantial reallocation of patients between primary care and specialist nephrology care with only a small increase in numbers eligible, ensuring those at higher risk of progression are identified.
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What Socratic holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.