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Research

Nephrologist referrals of elderly CKD patients in Singapore: A cross-sectional study

Wei Beng Tan, Anna Szücs, Sarah M Burkill, Shih Hui Ong, Doris Young and Lay Hoon Goh
BJGP Open 22 March 2022; BJGPO.2021.0155. DOI: https://doi.org/10.3399/BJGPO.2021.0155
Wei Beng Tan
1 National University Polyclinics, National University Health System, Singapore, Singapore
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Anna Szücs
2 Division of Family Medicine, Department of Medicine, National University of Singapore, Singapore, Singapore
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Sarah M Burkill
3 Saw Swee Hock School of Public Health, National University Singapore, Singapore, Singapore
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Shih Hui Ong
4 Regional Health System Office, National University Health System, Singapore, Singapore
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Doris Young
5 Division of Family Medicine, Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
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Lay Hoon Goh
1 National University Polyclinics, National University Health System, Singapore, Singapore
5 Division of Family Medicine, Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
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Abstract

Background Chronic kidney disease (CKD) is common in the elderly population. By 2035, approximately one-quarter of Singapore residents are expected to have CKD. Many of these patients are not referred to nephrologists.

Aim We aimed to compare the characteristics of elderly (≥ 65 years old) patients with stage 3B CKD and above in the referral and non-referral groups.

Design and settings A cross-sectional study in the primary care organisation National University Polyclinics (NUP), Singapore.

Method Retrospective data were extracted from the electronic health records of CKD patients (≥ 65 years old) with stage 3B CKD and above.

Results From 1 January to 31 December 2018, a total of 1,536 patients aged 65 years or older were diagnosed with stage 3B CKD or above (non-referral group =1,179 vs. referral group =357). The mean patient age in the non-referral group (78.3 years) was older than that in the referral group (75.9 years) (P<0.001). Indian elderly patients were referred more compared to their Chinese counterparts (P=0.008). The non-referral group was prescribed significantly less fibrate, statins, insulin, sulfonylureas, dipeptidyl peptidase-4 inhibitors, and antiplatelet than the referral group (P<0.05), but only the difference in fibrates remained significant on subsequent multivariate analysis.

Conclusions This study demonstrates that there is a considerable number of elderly CKD patients exclusively managed in the primary care setting (n = 1,179) and that referrals primarily depend on demographic factors, namely age and ethnicity, rather than medical determinants of CKD severity or case complexity.

  • CKD
  • elderly
  • primary health care
  • referral
  • nephrology
  • family medicine
  • population health
  • Received August 20, 2021.
  • Revision received January 8, 2022.
  • Accepted March 8, 2022.
  • Copyright © 2022, The Authors

This article is Open Access: CC BY license (https://creativecommons.org/licenses/by/4.0/)

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Accepted Manuscript
Nephrologist referrals of elderly CKD patients in Singapore: A cross-sectional study
Wei Beng Tan, Anna Szücs, Sarah M Burkill, Shih Hui Ong, Doris Young, Lay Hoon Goh
BJGP Open 22 March 2022; BJGPO.2021.0155. DOI: 10.3399/BJGPO.2021.0155

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Accepted Manuscript
Nephrologist referrals of elderly CKD patients in Singapore: A cross-sectional study
Wei Beng Tan, Anna Szücs, Sarah M Burkill, Shih Hui Ong, Doris Young, Lay Hoon Goh
BJGP Open 22 March 2022; BJGPO.2021.0155. DOI: 10.3399/BJGPO.2021.0155
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Keywords

  • CKD
  • elderly
  • primary health care
  • referral
  • nephrology
  • family medicine
  • population health

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