Early referral strategies for patients with markers of renal disease

Nephrology services traditionally have been directed towards the identification and care of patients with advanced kidney disease. There is evidence that late referral has implications in terms of poorer outcomes for patients with chronic kidney disease (CKD) and that they are at increased risk of cardiovascular disease. We aim to assess the clinical- and cost-effectiveness of early referral strategies for people with markers of kidney disease. Methods will include: Systematic review of the published literature to assess the evidence for the clinical effectiveness of early referral strategies for CKD. Systematic review of the published literature to assess cost effectiveness. Economic analysis - informed by the findings of the systematic reviews, to model the economic implications of different early referral strategies Searches will include MEDLINE, EMBASE, HMIC, NHS EED, HEED and the Cochrane Library. Review of titles and abstracts, data extraction and quality assessment will be conducted by two reviewers, using a specifically designed tool. Results will be reported narratively and summarised in tabular form. If appropriate, meta-analysis will be conducted. Modelling will be used to estimate cost-effectiveness. Sensitivity analysis will be undertaken to analyse and quantify the impact of uncertainty in study results.