Landelijke Transmurale Afspraak Chronische Nierschade: doorverwijzingen in de praktijk

Menting, N. (Nicole) (2013) Landelijke Transmurale Afspraak Chronische Nierschade: doorverwijzingen in de praktijk. thesis, Medicine.

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Abstract

Background: In 2009 the National Transmural Agreements on Chronic Kidney Disease (LTA-CN) were published. These agreements include guidelines about the care of patients with chronic kidney disease in the general practice. It is known that late nephrology referral in patients with chronic kidney disease is associated with increased morbidity, hospitalization and mortality. The aim of this study is to map how many patients are referred to a nephrologist according to the guidelines stated in the National Transmural Agreements. Methods: In this retrospective cohort study patients were included if according to abnormal laboratory investigation in 2011 in the general practice the National Transmural Agreements would advise immediate referral to a nephrologist. Two cohorts were formed: patients ≥ 65 years and patients < 65 years. Variables like age, eGFR and visits to a nephrologist were gathered from the hospital’s information system. Results: The cohort with patients ≥ 65 years shows that 61,7% of the 162 included patients has visited a nephrologist. The patients of this cohort that are not familiar to nephrologists care are older (median 87,5 years versus 83 years) and more of these patients died (71% versus 58%). The cohort with patients < 65 years shows that 62,5% of the 62 included patients has visited a nephrologist. In this cohort patients that did not visit a nephrologist had a higher eGFR (median 42,5 ml/min/1,73m2 versus 35,5 ml/min/1,73m2). Conclusion: Almost two thirds of the patients around Amersfoort with known chronic kidney disease in the general practice are referred to nephrologic care as is advised in the National Transmural Agreements. The patients who have not visited a nephrologist are older, have a higher eGFR and in this group more patients died. Other studies also show that a considerable part of the patients with kidney disease are not referred to a nephrologist as is advised in the guidelines. To realize a higher referral-rate patients with chronic kidney disease could be actively traced and easy accessible consultation of nephrologists could have a positive influence.

Item Type:	Thesis (Thesis)
Supervisor name:	Legdeur, Dr. M.C.J.C.
Supervisor name:	Bosma, Dr. R.J. and Interne Geneeskunde and Meander Medisch Centrum te Amersfoort
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 11:03
Last Modified:	25 Jun 2020 11:03
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/2334

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