# Clinical outcomes of the pilot project Nephrology Liaison Clinic in a primary care clinic: A retrospective observational study

## TL;DR

A pilot project integrating nephrology into primary care showed success in slowing kidney disease and improving diabetes control.

## Contribution

Demonstrates the feasibility of a nephrology liaison clinic in primary care for managing chronic kidney disease.

## Key findings

- 61.6% of patients remained in primary care after one year with stabilized or slowed kidney function decline.
- HbA1c improved in 10 patients, and 13 new patients started on sodium-glucose cotransporter-2 inhibitors.
- 38.4% of patients were referred to tertiary care, mainly for renal replacement therapy preparation.

## Abstract

The pilot project Nephrology Liaison Clinic, initiated in 2019 at Klinik Kesihatan Sentul, integrates nephrology services into primary care. Managed by primary care physicians with periodic nephrologist input, this project aims to enhance early intervention and reduce tertiary care burdens.

In this retrospective study, the clinical outcomes of patients enrolled from 2019 to 2021 were analysed. Patients with chronic kidney disease stage G3 or stage G4/G5 declining hospital referral and those with persistent proteinuria were included. Patients who were lost to follow-up, deceased or transferred to other clinics were excluded. Data analysis included descriptive statistics, the chi-square test, Fisher’s exact test and McNemar test.

A total of 73 patients were included. After 1 year, 45 (61.6%) remained under primary care, while 28 (38.4%) required tertiary referral, predominantly for renal replacement therapy preparation. Among the primary care patients, 71.1% (32/45) either had maintained or slowed estimated glomerular filtration rate decline. Ten patients had their HbA1c improved from >8% to <8% (p = 0.002), and 13 more patients were initiated on sodium-glucose cotransporter-2 inhibitors compared to baseline (p < 0.001).

This study demonstrates the feasibility of nephrology liaison clinics in stabilising renal function and improving metabolic parameters within primary care settings. The findings highlight the potential of shared-care models in resource-limited settings. However, challenges remain in ensuring adequate human resources and improving access to renoprotective medications. Larger-scale, longterm studies are warranted to validate the long-term benefits and wider applicability of this integrated approach.