Introduction Chronic kidney disease (CKD) affects > 10% of the population but not all CKD patients require referral to a nephrologist. Various recommendations for referral to nephrologists are proposed worldwide. We examined the profile of French patients consulting a nephrologist for the first time and compared these characteristics with the recommendations of the International Kidney Disease: Improving Global Outcomes (KDIGO), the French "Haute Autorité de Santé" (HAS), and the Canadian Kidney Failure Risk Equation (KFRE). Methods University Hospital electronic medical records were used to study patients referred for consultation with a nephrologist for the first time from 2016 to 2018. Patient characteristics (age, sex, diabetic status, estimated glomerular filtration rate (eGFR) and urine protein-to-creatinine ratio (PCR), etiology reported by the nephrologist) and 1-year patient follow-up were analyzed and compared with the KDIGO, HAS and Canadian-KFRE recommendations for referral to a nephrologist. The stages were defined according to the KDIGO classification, based upon kidney function and proteinuria. ResultsThe 1,547 included patients had a median age of 71 [61-79] years with 56% males and 37% with diabetes. The main nephropathies were vascular (40%) and glomerular (20%). The KDIGO classification revealed 30%, 47%, 19%, 4% stages G1-2 to G5, and 50%, 22%, 28% stages A1-A3, respectively. According to KDIGO, HAS and KFRE scores, nephrologist referral was indicated for 42%, 57% and 80% of patients respectively, with poor agreement between recommendations. Furthermore, we observed 890 (57%) patients with an eGFR> 30 ml/min and a urine protein to creatinine ratio 0.5 g/g, mostly aged over 65 years (67%); 40% were diabetic, and 57% had a eGFR > 45 ml/min/1.73m 2 , 56% were diagnosed as vascular nephropathy and 11% with unknown nephropathy. Conclusion These results underline the importance of better identifying patients for referral to a nephrologist and informing general practitioners. Other referral criteria (age and etiology of the nephropathy) are debatable.

No abstract

No abstract

Background and Aims Chronic kidney disease (CKD) is a common disease with a heterogeneous course. The Kidney Failure Risk Equation (KFRE) is designed to predict 5-year End stage renal disease (ESRD). This score has shown poor performance in predicting 5-years ESRD in elderly patients, probably because of a competitive risk with death. Indeed, patients with type 2 diabetes are numerous and older than non-diabetic patients, with higher risks of death, and thus à higher competitive risk. In this context, we aimed to evaluate the performance of the KFRE score at 5 years, in a cohort from a tertiary center, according to diabetic status. Method The CKD Caremeau (CKDC) cohort is a single-center tertiary cohort of adults seen by a nephrologist for CKD. We studied CKDC patients included between January 2008 and December 2017 and followed them. We excluded patients younger than 45 years. KFRE score covariates were collected at the first visit, and Renal replacement therapy (RRT) (dialysis or kidney transplantation) and death before ESRD were collected during follow-up through December 2022. Multiple imputation (Monte Carlo) was used for missing albuminuria. Score performance was calculated with discrimination (area under curve (AUC)) and calibration (observed versus predicted risks), according to diabetic status, at 5 years. Results Of the 3046 patients included, 1288 (42%) had diabetes. 558 (18%) albuminuria were missing and imputed. For diabetic patients, median follow-up time was 5.3 [3.0–7.6] years, median age was 73 [66–80] years, 843 (65%) patients were males, median eGFR was 38 [27–50], median albuminuria was 204 [57–671] mg/g, 177 (14%) developed ESRD, and 398 (30%) died, with a median 5-years KFRE score of 4 [0.65–17.6] %. For non-diabetic patients, median time of follow-up was 5.5 [3.3–8.2] years, median age was 72 [63–81] years old, 1027 (58%) were males, median eGFR was 40 [27–53], median albuminuria was 113 [38–399] mg/g, 205 (12%) experimented ESRD, and 501 (29%) died, with a median 5-year KFRE score of 2 [0.18–14] %. Discrimination was not modified by diabetic status at 5 years (p = 0.67). Calibration was also unaffected by diabetic status, with an overall overestimation at 5 years. Conclusion The performance of the KFRE score was not modified by diabetic status, meaning that age is probably more important than diabetic status for the competitive risk of death in CKD patients.

No abstract