Regular nephrologist visits beneficial for primary healthcare patients

A study recently published in the Medical Journal of Malaysia reveals the benefits of incorporating regular nephrologist visits into the primary care regimen of patients with chronic kidney disease (CKD). [2024;79(2):141–145]

The study, which took place at Greentown Health Clinic in Ipoh, Perak, aimed to assess the clinical outcomes of CKD patients in a primary healthcare setting before and after referral to a nephrologist. It looked at the medical records of 87 CKD patients at stages 3b, 4, and 5, who underwent at least one consultation with a visiting nephrologist between January 2019 and December 2021. Key clinical parameters including blood pressure, urine protein, fasting blood sugar, glycated hemoglobin (HbA_1c), serum creatinine, estimated glomerular filtration rate (eGFR), and fasting lipid profile were tracked, and values before and after the nephrologist visits were tracked.

The findings revealed significant improvements in clinical outcomes post-referral, notably in systolic and diastolic blood pressure, as well as total cholesterol and LDL-C levels. These improvements suggest that nephrologist consultations play a critical role in the optimization of therapy for CKD patients, potentially slowing the disease progression and reducing the risk of cardiovascular complications, which are common in patients with advanced CKD.

Interestingly, the study did not find significant changes in HDL-C levels or other outcome variables, including eGFR and HbA_1c, indicating that while nephrologist interventions can lead to notable improvements in certain areas, managing CKD is complex and requires a multifaceted approach. The study highlighted the importance of early detection and timely intervention in the management of CKD. Through the National Action Plan for Healthy Kidneys (ACT-KID) initiated by the MOH Malaysia, efforts are being made to improve the management of CKD and establish collaborative care between primary healthcare providers and nephrologists.

Despite the positive results, there were limitations such as a small sample size and the impact of the COVID-19 pandemic on patient referrals. Moreover, the researchers suggested that future studies should include control groups and standardized criteria for post-referral investigations to further validate the findings.

This study is a reflection of the significant impact of incorporating nephrologist visits into primary care on the clinical outcomes of CKD patients. It not only supports the multidisciplinary approach in managing CKD but also sets a precedent for future research and policy making to enhance patient care and mitigate the socioeconomic burden of CKD on the healthcare system.

CKD represents a significant public health challenge, not only in Malaysia but globally, with a rising prevalence correlated to the increase in non-communicable diseases such as type 2 diabetes and hypertension. In Malaysia, the incidence of CKD has seen a worrying increase from 9.1 percent in 2011 to 15.48 percent in 2018, highlighting an urgent need for effective management strategies to slow down the disease progression and improve patient outcomes. [BMC Nephrol 2020;21:344]