TY - GEN A1 - Weckmann, Gesine A1 - Chenot, Jean-François A1 - Stracke, Sylvia A1 - Haase, Annekathrin A1 - Spallek, Jacob A1 - Angelow, Aniela T1 - Auswirkung von Überweisungskriterien zum Nephrologen bei chronischer Niereninsuffizienz – Analyse einer Populationsbasierten Stichprobe T2 - Das Gesundheitswesen Y1 - 2017 U6 - https://doi.org/10.1055/s-0037-1605664 SN - 1439-4421 SN - 0941-3790 VL - 79 IS - 08/09 SP - 656 EP - 804 ER - TY - GEN A1 - Weckmann, Gesine A1 - Stracke, Sylvia A1 - Haase, Annekathrin A1 - Spallek, Jacob A1 - Ludwig, Fabian A1 - Angelow, Aniela A1 - Emmelkamp, Jetske M. A1 - Mahner, Maria A1 - Chenot, Jean-François T1 - Diagnosis and management of non-dialysis chronic kidney disease in ambulatory care: a systematic review of clinical practice guidelines T2 - BMC Nephrology N2 - Background: Chronic kidney disease (CKD) is age-dependent and has a high prevalence in the general population. Most patients are managed in ambulatory care. This systematic review provides an updated overview of quality and content of international clinical practice guidelines for diagnosis and management of non-dialysis CKD relevant to patients in ambulatory care. Methods: We identified guidelines published from 2012-to March 2018 in guideline portals, databases and by manual search. Methodological quality was assessed with the Appraisal of Guidelines for Research and Evaluation II instrument. Recommendations were extracted and evaluated. Results: Eight hundred fifty-two publications were identified, 9 of which were eligible guidelines. Methodological quality ranged from 34 to 77%, with domains “scope and purpose” and “clarity of presentation” attaining highest and “applicability” lowest scores. Guidelines were similar in recommendations on CKD definition, screening of patients with diabetes and hypertension, blood pressure targets and referral of patients with progressive or stage G4 CKD. Definition of high risk groups and recommended tests in newly diagnosed CKD varied. Conclusions: Guidelines quality ranged from moderate to high. Guidelines generally agreed on management of patients with high risk or advanced CKD, but varied in regarding the range of recommended measurements, the need for referrals to nephrology, monitoring intervals and comprehensiveness. More research is needed on efficient management of patients with low risk of CKD progression to end stage renal disease. KW - Chronic kidney disease KW - Management KW - Clinical practice guideline KW - Systematic review Y1 - 2018 U6 - https://doi.org/10.1186/s12882-018-1048-5 SN - 1471-2369 IS - 19 ER - TY - GEN A1 - Weckmann, Gesine A1 - Haase, Annekathrin A1 - Spallek, Jacob A1 - Chenot, Jean-François A1 - Stracke, Sylvia A1 - Angelow, Aniela T1 - Public health implications of referral criteria for chronic kidney disease, population based analysis T2 - European Journal of Public Healt N2 - Background: Chronic Kidney Disease (CKD) has an age-dependent prevalence of 10% in adults. The majority of CKD patients are treated in general practice. Although international guidelines recommend referral in patients with GFR <30, the German Societies for Nephrology and Internal Medicine recommend specialist referral for all subjects with estimated glomerular filtration rate (eGFR) <45 or eGFR 45-59 ml/min/ 1,73m2 with additional risk factors. This analysis was performed to evaluate the public health implications of lowering the threshold value for referral. Methods: Data of the population based cohort Study of Health in Pomerania (SHIP-2) were analysed to estimate the proportion of subjects who meet different referral criteria, billing data to estimate actual referral rate and public health implications of implementing different referral criteria were estimated with regard to cost and health resources utilization. Results: Data of 2328 subjects from SHIP-2 (53% female; age M = 57 Jahre, SD = 14)were analyzed. 3% of subjects had eGFR<45ml/min/1,73m2. 6% had an eGFR between 45-59 ml/min/1,73m2. Proposed German referral criteria were met by 8% of subjects, with 41% in the age group 80+ meeting referral criteria, wheras NICE and KDIGO criteria limited referral to 1-2%. Yearly referral as estimated from billing data was ca.2%. Results are preliminary and data comparing cost and health resources utilization will be available at the conference. Conclusions: Adherence to the proposed German referral criteria would greatly increase the number of referrals, especially in the elderly. This can lead to a major increase in cost, as well as serious problems with respect to the capacity of the nephrological workforce. Because of lack of a specific nephrological therapy in earlier stages of CKD in patients without additional risk factors, the benefit of increasing referrals in this group seems doubtful. Referral criteria for common medical conditions should be evaluated rigorously. KW - patient referral KW - public health medicine KW - kidney failure KW - chronic Y1 - 2018 U6 - https://doi.org/10.1093/eurpub/cky218.167 SN - 1101-1262 SN - 1464-360X VL - 28 IS - 4 SP - 466 EP - 466 ER -