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

Abstract

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.