Who do we discharge from renal clinic and what does it mean for primary care

BACKGROUND: It is unclear whether discharging patients from renal clinic to primary care is safe. AIM: To determine the characteristics, primary care monitoring and renal outcomes of patients discharged from renal clinic. DESIGN AND SETTING: A retrospective study of 2236 adults discharged from a tertiary renal clinic between 2013-2018. METHOD: Patient demographics, primary renal disease, laboratory results and timeline dates were collected from the renal IT system. Timing of blood tests, renal progression, needing dialysis and patient survival were analysed. Reasons for discharge and cause of disease progression were reviewed in patients developing new estimated glomerular filtration rate 10 ml/min/1.73 m2. Only 132 patients (6%) developed new advanced chronic kidney disease (estimated glomerular filtration rate < 20 ml/min/1.73 m2) of whom 40% were palliative, 36% had developed acute kidney injury and 23% discharged for failing to attend clinic. One hundred and thirty-four patients (6%) were referred back to nephrology and eight started dialysis of whom six were discharged for failure to attend clinic. CONCLUSION: Most discharged patients are low risk of progressive renal disease and need infrequent monitoring. Non-adherent patients discharged for failing to attend appear to be at risk of poor outcomes and new strategies are needed to better support this population.