Table 1

Characteristics of included studies

StudyHealthcare setting, countryStudy designPopulation, NKFRE detailsInclusion/exclusion criteriaInterventionControlEnd-pointsFollow-up
Hingwala et al18*Primary to nephrology care, Manitoba, CanadaQuasiexperimentalPatients referred to three renal centres in the Manitoba Renal Program, n/a4-variable KFRE for 5-year risk12-month period immediately following implementation of triage was observed as a transition period to the new triage system and was excluded from the final analysis.

No triage unless all four variables available or other indication provided.
Referral if significant criteria OR KFRE 5-year risk >3%. If no criteria met, then back to referrer with ‘low risk letter’.

If risk 3%–10% book as non-urgent (<6 months).

If risk >10% book as urgent (<4 weeks).
Pretriage: no set criteria. Referrals triaged as urgent, non-urgent or ‘do not book’ by an individual rotating nephrologist.Compared between pretriage and post-triage periods:
  1. Wait time between referral and nephrology visit (days).

  2. Number of consults.

Pretriage 1 January 2011 to 31 December 2011.

Post-triage 1 January 2013 to 31 December 2013
Hong et al20Primary to nephrology care, New South Wales, AustraliaPre–postPatients referred to St George Hospital Renal Department, n/aKFRE for 5-year risk, unclear on number of variablesn/aIn January 2019 triage consultant and risk-based triage introduced.

Referral if KFRE 5-year risk >3%.

If <3% risk, referral on consultant discretion.
Pretriage periods in 2018 and 2017.Number of consults between pretriage and post- triage periods.2017–2019
Smekal et al3 *Multidisciplinary to general nephrology care, Alberta, CanadaMixed-methodsInterviews, 27: Southern Alberta Renal Program, nine patients and one family member; multidisciplinary CKD healthcare providers in Calgary, Alberta: 17.

Survey in Calgary, Alberta: patients from CKD clinics: 413; CKD healthcare providers: 73.
KFRE for 2-year risk, unclear on number of variablesInterviews: patients age >18 years with non-dialysis CKD, discharged from multidisciplinary to general nephrology care and multidisciplinary CKD healthcare providers (nephrologists, nurses and allied health professionals).

Survey: all patients from CKD multidisciplinary and general nephrology clinics and all multidisciplinary CKD healthcare providers.
Transition to CKD multidisciplinary clinic when KFRE 2-year risk ≥10% or eGFR ≤15 mL/min/1.73 m2 implemented in 2017.

Interviews postimplementation.

Surveys postimplementation: patient: paper-based care experience survey and provider: online job satisfaction survey.
Surveys preimplementation: patient: paper-based care experience survey and provider: online job satisfaction survey.Interview data collection stopped once data saturation reached.

Survey responses returned within time period.
Survey distributed to patients November 2016–January 2017 (preimplementation) and January 2018–March 2018 (postimplementation).

Survey responses from providers November 2016–January 2017 (preimplementation) and April 2018 (postimplementation).
Che et al19Discharges from multidisciplinary care, Ontario, CanadaRetrospective cohortPrevalent CKD patients in MCKC in 2013 with available data: 643.4-variable KFRE for 2-year and 5- year riskIncluded CKD patients from MCKC with available data.Revised eligibility criteria between 2016 and 2018 from eGFR <30 mL/min/1.73 m2 to eGFR <15 mL/min/1.73 m2 and KFRE 2-year risk >10%.

If not eligible, then discharged from MCKC.
n/aNumber discharged from MCKC, rereferred, commenced RRT and died.2013–January 2020
Sendak et al21Private care, North Carolina, USAProspective cohortDuke Connected Care a MSSP, 413.KFRE for 2-year risk, unclear on number of variablesPatients alive and without evidence of ESKD.

Excluded if had past nephrology visit and those with AKI without chronic dysfunction.
Patients with a KFRE 2-year risk >15% referred for ‘population health rounding’ – in-depth EHR weekly review with MDT to decide on changes in managementn/aNumber of patients rounded per month, time per case during rounds, % of patient at rounds that have action taken, incidence of ESKD, RRT modality, number of dialysis crash-starts.June 2015 for 5 months
  • *Full text.

  • †Conference abstract.

  • AKI, acute kidney injury; CKD, chronic kidney disease; eGFR, estimated glomerular filtration rate; EHR, electronic health record; ESKD, end-stage kidney disease; KFRE, Kidney Failure Risk Equation; MCKC, Multi-Care-Kidney-Clinic; MDT, multidisciplinary team; MSSP, Medicare Shared Savings ProgramProgramme; N, number; n/a, not available; RRT, renal replacement therapy.