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Open Access Research article

Limited referral to nephrologists from a tertiary geriatric outpatient clinic despite a high prevalence of chronic kidney disease and anaemia

Neil Boudville12*, Kalindu Muthucumarana2 and Charles Inderjeeth13

Author Affiliations

1 School of Medicine and Pharmacology, University of Western Australia, Verdun Street, Nedlands, WA, Australia

2 Department of Renal Medicine, Sir Charles Gairdner Hospital, Verdun Street, Nedlands, WA, Australia

3 Department of Aged Care and Rehabilitation, Sir Charles Gairdner Hospital, Verdun Street, Nedlands, Western Australia

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BMC Geriatrics 2012, 12:43  doi:10.1186/1471-2318-12-43

Published: 3 August 2012

Abstract

Background

Chronic kidney disease (CKD) is increasing in prevalence world-wide with the largest growth being in the elderly. The aim of this study was to examine the prevalence of CKD in a geriatric outpatient clinic within a tertiary hospital and its association with anaemia and mortality with a focus on the referral patterns towards nephrologists.

Methods

Retrospective study utilising administrative databases. The cohort was defined as all patients that attended the geriatric outpatient clinics of a single tertiary hospital within the first 3 months of 2006. Patients were followed for 18 months for mortality and referral to a nephrologist.

Results

The mean Glomerular filtration rate (eGFR) of the 439 patients was 67.4 ± 29.1 mL/min/1.73 m2 (44% <60 mL/min/1.73 m2). 11.8% had a haemoglobin < 110 g/L, with anaemia being significantly associated with kidney function in those with a eGFR < 60 mL/min/1.73 m2 (p = 0.0092). Kidney function and anaemia were significantly associated with mortality on multivariate analysis (p = 0.019 and p = 0.0074). After 18 months, 8.8% of patients with CKD were referred to a nephrologist.

Conclusion

Despite a high prevalence of CKD in patients attending a geriatric outpatient clinic and its association with anaemia and mortality, few of these patients were referred to a nephrologist. An examination of the reasons behind this bias is required.

Keywords:
Anaemia; Chronic kidney failure; Geriatrics; Referral and consultation