Nephrology review frequency, associated factors, and outcomes among people with chronic kidney disease G5: a population-based cohort study in England.

BACKGROUND: Nephrologists support decision-making and preparation for kidney replacement therapy (KRT) and conservative kidney management (CKM). However, the frequency of nephrology review among people with chronic kidney disease (CKD) G5 has not been well characterised at the population level. METHODS: We identified adults in England who reached CKDG5 between 2013-2018 using Clinical Practice Research Datalink Aurum, a primary care database covering 16.1% of the UK population, linked to Hospital Episode Statistics. Review frequency was defined as the annualised number of 90-day quarters with ≥1 nephrology-coded outpatient attendance or inpatient admission during the 720 days before and after index. We examined factors associated with review frequency and estimated adjusted outcome probabilities. RESULTS: Among 4,781 patients (44.2% female; median age, 74 years), 872 (18.2%) died without KRT and 2,614 (54.7%) initiated KRT, including 795 (16.6%) inpatient dialysis initiations. Lower review frequency was associated with older age, female sex, greater deprivation, dementia, and cerebrovascular disease, whereas Asian and Black ethnicity were associated with higher frequency than White ethnicity. Lower review frequency was associated with less KRT initiation and higher proportions of death without KRT and inpatient dialysis initiation. CONCLUSIONS: We provide a population-based description of the heterogeneity in nephrology contact and subsequent treatment pathways among people reaching CKDG5 by age, sex, deprivation, frailty, comorbidity, and ethnicity. These observational data highlight the need to better understand equity in access to nephrology care and the diverse care needs of people with CKDG5 beyond preparation for KRT.