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During the congress, E-Posters will be accessible to all participants on the congress website 24/7, as well as in the E-poster stations in the congress center.
Preparing your E-Poster
Please review the E-Poster format requirements carefully when preparing your E-Poster. Should your E-Poster not meet the mentioned requirements, it may not be displayed as described above.
E-Poster Submission Deadline
Please prepare and upload your E-Poster no later than March 14, 2026 11.59PM CET. After this date, you will no longer be able to prepare and upload your E-poster and it will not be displayed and accessible on the congress website.
Please follow the instructions below to input your abstract title.
Abstract titles should be brief and reflect the content of the abstract.
The rising prevalence in chronic kidney disease (CKD) has led an increase in referrals to kidney specialists. This has inadvertently resulted in a large volume of referral of patients who do not require specialist kidney care and has further strained the global nephrology workforce. There remains limited data on interventions to enhance referral patterns from primary care to nephrology. We conducted a systematic review of studies assessing interventions for reducing wait times, decreasing the volume of referrals, and/or increasing proportion of guideline concordant referrals from primary care to specialized kidney care services across all world regions.
We leveraged MEDLINE, Embase, Cochrane Library, CINAHL, Web of Science and PsycINFO for studies (from inception to April 15, 2024) reporting interventions aimed at decreasing referral volume, reducing wait-times, and/or increasing guideline-concordant referrals in adult patients with CKD from primary care to nephrology. Interventions were further classified into taxonomy of initiatives, specific type of intervention, and whether they were single vs. multi-faceted interventions. Primary outcomes included changes to referral volume, wait-times, and proportion of guideline-concordant referrals. Data was pooled using a random effects model and meta-analyses were conducted using pooled mean-difference (MD) and odds-ratios (OR).
Our search yielded 33 studies, with 20 studies reporting single interventions and 13 using more than one intervention. None of the studies took place in low- or middle-income countries (LMIC). Overall, interventions resulted in an increase in total referrals (MD: 19 referrals per month, 95% CI, 7 to 30; I2=98%; P<0.001) and a non-significant decrease in the proportion of guideline-concordant referrals (OR: 0.32, 95% CI, 0.09 to1.16; I2=100%; P=0.08). Financial, regulatory, or legislative incentives (n=2) led to an increase in guideline-concordant referrals (OR: 1.15, 95% CI, 1.02 to1.29; I2: 0%; P=0.02). Organizational changes showed a non-significant reduction in wait-time of 24 days (95% CI -64 to 15, I2 = 99%; P =0.23) but tended to decrease guideline concordant referrals (OR: 0.17, 95% CI, 0.03 to 0.86; I2: 100%; P=0.03).
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Overall, interventions largely increased referral volume and decreased guideline-concordant referrals. Organizational changes tended to decrease wait-times. Our work signals the need for further work in designing and implementing strategies to enhance referral patterns to nephrology, particularly from LMIC. The data has implications for designing programs to improve primary care-nephrology interface in kidney disease management. Select content from this abstract has previously been presented at the 2023 ASN Kidney Week Meeting.
