• Family practice · Mar 2020

    Who do we discharge from renal clinic and what does it mean for primary care?

    • Rhodri Pyart, Sheryl Lim, Bilal Hussein, Steve Riley, and Gareth Roberts.
    • Department of Nephrology and Transplantation, University Hospital of Wales, Cardiff, UK.
    • Fam Pract. 2020 Mar 25; 37 (2): 187-193.

    BackgroundIt is unclear whether discharging patients from renal clinic to primary care is safe.AimTo determine the characteristics, primary care monitoring and renal outcomes of patients discharged from renal clinic.Design And SettingA retrospective study of 2236 adults discharged from a tertiary renal clinic between 2013-2018.MethodPatient demographics, primary renal disease, laboratory results and timeline dates were collected from the renal IT system. Timing of blood tests, renal progression, needing dialysis and patient survival were analysed. Reasons for discharge and cause of disease progression were reviewed in patients developing new estimated glomerular filtration rate <20 ml/min/1.73 m2.ResultsPatients were older (median age 75; interquartile range 63-84) with non-progressive, seemingly non-proteinuric renal disease. Median time to repeat blood test post-discharge was 75 days with 90% tested within 12 months. Sixty-six percent saw an improvement in kidney function post-discharge and only 13% had a decline of >10 ml/min/1.73 m2. Only 132 patients (6%) developed new advanced chronic kidney disease (estimated glomerular filtration rate < 20 ml/min/1.73 m2) of whom 40% were palliative, 36% had developed acute kidney injury and 23% discharged for failing to attend clinic. One hundred and thirty-four patients (6%) were referred back to nephrology and eight started dialysis of whom six were discharged for failure to attend clinic.ConclusionMost discharged patients are low risk of progressive renal disease and need infrequent monitoring. Non-adherent patients discharged for failing to attend appear to be at risk of poor outcomes and new strategies are needed to better support this population.© The Author(s) 2019. Published by Oxford University Press. All rights reserved.For permissions, please e-mail: journals.permissions@oup.com.

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