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Title: Nephrologist referrals of elderly CKD patients in Singapore: A cross-sectional study.
Authors: Tan, Wei Beng
Szücs, Anna
Burkill, Sarah M
Ong, Shih Hui
Young, Doris
Goh, Lay Hoon 
Keywords: CKD
family medicine
population health
primary health care
Issue Date: 22-Mar-2022
Publisher: Royal College of General Practitioners
Citation: Tan, Wei Beng, Szücs, Anna, Burkill, Sarah M, Ong, Shih Hui, Young, Doris, Goh, Lay Hoon (2022-03-22). Nephrologist referrals of elderly CKD patients in Singapore: A cross-sectional study.. BJGP Open : BJGPO.2021.0155-. ScholarBank@NUS Repository.
Abstract: BACKGROUND: Chronic kidney disease (CKD) is common in the elderly population. By 2035, approximately one-quarter of Singapore residents are expected to have CKD. Many of these patients are not referred to nephrologists. AIM: We aimed to compare the characteristics of elderly (≥ 65 years old) patients with stage 3B CKD and above in the referral and non-referral groups. DESIGN AND SETTINGS: A cross-sectional study in the primary care organisation National University Polyclinics (NUP), Singapore. METHOD: Retrospective data were extracted from the electronic health records of CKD patients (≥ 65 years old) with stage 3B CKD and above. RESULTS: From 1 January to 31 December 2018, a total of 1,536 patients aged 65 years or older were diagnosed with stage 3B CKD or above (non-referral group =1,179 vs. referral group =357). The mean patient age in the non-referral group (78.3 years) was older than that in the referral group (75.9 years) (P<0.001). Indian elderly patients were referred more compared to their Chinese counterparts (P=0.008). The non-referral group was prescribed significantly less fibrate, statins, insulin, sulfonylureas, dipeptidyl peptidase-4 inhibitors, and antiplatelet than the referral group (P<0.05), but only the difference in fibrates remained significant on subsequent multivariate analysis. CONCLUSIONS: This study demonstrates that there is a considerable number of elderly CKD patients exclusively managed in the primary care setting (n = 1,179) and that referrals primarily depend on demographic factors, namely age and ethnicity, rather than medical determinants of CKD severity or case complexity.
Source Title: BJGP Open
ISSN: 2398-3795
DOI: 10.3399/BJGPO.2021.0155
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