Chronic kidney disease prevalence and nephrology service delivery in Newfoundland and Labrador health regions

Hossain, Mohammad Akhtar (2019) Chronic kidney disease prevalence and nephrology service delivery in Newfoundland and Labrador health regions. Masters thesis, Memorial University of Newfoundland.

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Abstract

Chronic kidney disease (CKD) is a major cause of morbidity and mortality among kidney patients in Newfoundland and Labrador (NL). This study aims to investigate the burden of CKD across geographic areas in NL and the utilization pattern for nephrology services. The ultimate goal is to inform future service planning in NL. This is a retrospective cohort study of 40,465 CKD patients’ administrative data recorded over a 5-year period (2011-15). We compared the differences in nephrology service accessibility and frequency of nephrologist visit follow-up among the four health regions. P<0.05 was considered statistically significant. This study found that only 7.3% of NL CKD patients were in contact with nephrologists within one year of CKD being identifiable based on estimated glomerular filtration rate (eGFR). Male CKD patients have a 1.4-fold (OR, 1.4; 95% CI, 1.3-1.5 (p < 0.05) higher chance of seeing a nephrologist than female CKD patients. Among diabetic patients, only 12.8% of patients were tested for their urine albumin-creatinine ratio. On the other hand, only 4.5% of all CKD patients had a urine analysis performed. This is an underutilization of urine testing, which is a key diagnostic test that care-providers are failing to offer. Except for in the Eastern Regional Integrated Health Authority (ERIHA), patients from all other health regions faced difficulties in accessing nephrology care in their own regions. Development of telehealth and e-health programs and decentralizing CKD early detection and risk identification and care by a robust kidney outreach program would be useful for optimal CKD care in NL.

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