RT Journal Article
SR Electronic
T1 Nephrologist referrals of older patients with chronic kidney disease in Singapore: a cross-sectional study
JF BJGP Open
JO BJGP Open
FD Royal College of General Practitioners
SP BJGPO.2021.0155
DO 10.3399/BJGPO.2021.0155
VO 6
IS 3
A1 Wei Beng Tan
A1 Anna Szücs
A1 Sarah M Burkill
A1 Ong Shih Hui
A1 Doris Young
A1 Goh Lay Hoon
YR 2022
UL http://bjgpopen.org/content/6/3/BJGPO.2021.0155.abstract
AB Background Chronic kidney disease (CKD) is common in the older population. By 2035, approximately one-quarter of Singapore residents are expected to have CKD. Many of these patients are not referred to nephrologists.Aim To compare the characteristics of older patients (aged ≥65 years) with CKD stage ≥3B in the referral and non-referral groups.Design & 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 patients with CKD (aged ≥65 years) with CKD stage ≥3B.Results From 1 January–31 December 2018, a total of 1536 patients aged ≥65 years were diagnosed with CKD stage ≥3B (non-referral group = 1179 versus referral group = 357). The mean patient age in the non-referral group (78.4 years) was older than that in the referral group (75.9 years) (P<0.001). Indian older patients were referred more compared with their Chinese counterparts (P = 0.008). The non-referral group was prescribed significantly less fibrate, statins, insulin, sulfonylureas, dipeptidyl peptidase-4 (DPP4) inhibitors, and antiplatelet than the referral group (P<0.05), but only the difference in fibrates remained significant on subsequent multivariate analysis.Conclusion This study demonstrates that there is a considerable number of older patients with CKD exclusively managed in the primary care setting (n = 1179) and that referrals primarily depend on demographic factors, namely age and ethnic group, rather than medical determinants of CKD severity or case complexity.