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Kidney Week

Abstract: FR-PO1102

Insufficient Referral and Monitoring of CKD in Germany: A Nationwide, Retrospective Cohort Study

Session Information

Category: CKD (Non-Dialysis)

  • 2301 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

  • von Samson-Himmelstjerna, Friedrich A., University Hospital Schleswig-Holstein, Campus Kiel, Department of Nephrology and Hypertension, Kiel, Schleswig-Holstein, Germany
  • Steiger, Edgar, Central Research Institute of Ambulatory Health Care in Germany, Berlin, Germany
  • Kolbrink, Benedikt, University Hospital Schleswig-Holstein, Campus Kiel, Department of Nephrology and Hypertension, Kiel, Schleswig-Holstein, Germany
  • Schmitt, Roland, University Hospital Schleswig-Holstein, Campus Kiel, Department of Nephrology and Hypertension, Kiel, Schleswig-Holstein, Germany
  • Schulte, Kevin, University Hospital Schleswig-Holstein, Campus Kiel, Department of Nephrology and Hypertension, Kiel, Schleswig-Holstein, Germany
Background

Chronic kidney disease (CKD) is one of the most significant drivers of the global disease burden and an increasing public health issue. Adequate referral of high-risk patients to nephrologists is associated with improved management of CKD. Whether this is accomplished in Germany, a country with very high health care expenditure, is unknown.

Methods

We retrospectively analyzed outpatient claims data of 73,675,956 Germans who were covered by statutory health care in 2022.

Results

We identified 2,514,854 patients with prevalent CKD, 207,015 of which had CKD stage 4. Merely 134,132 (64.8%) patients with diagnosed CKD stage 4 received specialist care by a nephrologist in 2022. Failure to refer was associated with insufficient monitoring rates of kidney function and proteinuria. In a mixed logistic regression model, referral to nephrologists was less likely for women (odds ratio [OR] 0.72, 95% confidence interval [CI] 0.71-0.74), for higher age (OR per year 0.97, CI 0.96-0.97) and for nursing home inhabitants (OR 0.62, CI 0.60-0.64). These findings remained steady despite multi-variable adjustment for individual morbidity, population density, urbanization, and nephrologist density.

Conclusion

Our findings suggest serious short comings of the German health care system with inability to provide adequate referral to nephrology services for patients with late-stage CKD, particularly disadvantaging women, the elderly, and nursing home inhabitants. Change of public health policy is needed for better prevention of kidney failure as well as to reduce the CKD-associated burden of disease.

All statutory health care recipients with a diagnosis of CKD in the year 2022 were included. Only reconfirmed cases were included, meaning that a diagnosis of CKD was claimed in at least 1 additional quarter within 1 year after the initial diagnosis (M2Q) .