We recently contacted Dr. Scott Brimble, nephrologist at St. Joseph’s Hospital, as part of our reaching out to specialties across our LHIN.
They have recently reviewed their referral data and they have a 19% growth rate each of the past 4 years, which is unsustainable. Only 11% of referrals for CKD or proteinuria were deemed "appropriate" and/or provided the required information based on Kidneywise (which is: basically 2 eGFR and ACR values, eGFR<30, ACR> 60, or eGFR 30-45/ACR30-59).
So, there is much room for improvement in referring patients with kidney disease and eConsult provides an efficient, quick way to streamline the whole process.
According to Dr. Brimble, sensible reasons to use eConsult could include:
1.
Low eGFR
- eGFR 30-44 x 2, ACR<30 and you are worried (e.g. progressing, unable to achieve BP targets, metabolic complications,etc.);
- eGFR 20-29 x 2, ACR<30 and patient is frail, or travel a challenge, or things are stable/you are not too worried;
- a decline that you are worried about
2.
Proteinuria
- ACR>60, patient is frail, or travel travel a challenge;
- ACR 30-59, and you are worried (e.g. unable to achieve BP targets, evidence of eGFR decline, no obvious reason)
A recent case shows the utility of eConsult and the ability to engage in a bit of discussion in order to come up with a plan. The issue was a rising Creatinine, in a patient on a medication known to cause renal problems.
