Current guidelines for nephrology referral identified many patients at low risk for progression, according to a study published in American Journal of Kidney Diseases. Investigators conducted an observational cohort study of 399,644 veterans with chronic kidney disease from October 1, 2015 to September 30, 2016 to examine the number of patients identified for nephrology referral and their predicted risk for kidney failure. They found that 66,276 patients met laboratory indications for referral, 17.7% of whom were referred to nephrology in the following year. Among all patients meeting laboratory referral criteria, the median 2-year predicted risk for kidney failure was 1.5%. Potential referral volume would be reduced from 66,276 to 38,229 patients if referral was restricted to patients with a predicted risk greater than or equal to 1% in addition to laboratory indications. Basing referrals on predicted risk alone, a 2-year risk threshold of 1% or greater would identify a similar number of patients as laboratory-based criteria, with a median predicted risk of 2.3% among 72,948 patients. “A significant proportion of patients identified by laboratory-based indications for nephrology referral have a predicted risk of kidney failure less than 1%,” the authors wrote. “These findings may inform clinical decision support development to target nephrology referrals to patients most likely to benefit.”
US Kidney Transplant Outcomes Improving
Long-term survival rates have improved for kidney transplant recipients over the past 3 decades, according to a review published in New England Journal of Medicine. The 5-year survival rate among recipients who received kidneys from deceased donors increased from about 66% from 1996-1999 to approximately 78% from 2012-2015. Survival increased from 79.5% to approximately 88.0% among recipients who received kidneys from living donors. Improvements in tissue matching, organ distribution systems, surgical techniques, immune-suppressing medications, and post-transplant medical care have contributed to better survival rates, but—despite improvements in US kidney transplant recipients’ long-term survival—rates are below those of other developed nations, likely because immunosuppressant drugs are covered by Medicare for only 3 years after a transplant, according to the study authors. They also emphasized that COVID-19 is a serious threat to kidney transplant recipients, who have high mortality from the disease, noting that COVID-19 vaccines can reduce the rate and severity of infections but are less effective in transplant recipients when compared with the general population; a third booster vaccine may be beneficial, they added.