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Kidney Week

Abstract: PO0335

Testing Patterns for CKD-MBD Abnormalities Before and After Treatment

Session Information

Category: Bone and Mineral Metabolism

  • 402 Bone and Mineral Metabolism: Clinical

Authors

  • Wetmore, James B., Hennepin Healthcare, Minneapolis, Minnesota, United States
  • Ji, Yuanyuan, Chronic Disease Research Group, Minneapolis, Minnesota, United States
  • Ashfaq, Akhtar, OPKO Health Inc, Miami, Florida, United States
  • Gilbertson, David T., Chronic Disease Research Group, Minneapolis, Minnesota, United States
  • Roetker, Nicholas S., Chronic Disease Research Group, Minneapolis, Minnesota, United States
Background

We examined patterns of testing, treatment, and retesting after treatment initiation in CKD-MBD to determine if they were concordant with KDIGO guidelines.

Methods

We utilized 2010-19 data from IBM Explorys, an electronic health database. We created cohorts of incident CKD stage 3, 4, and 5 patients using a diagnosis code for CKD stage and a confirmatory eGFR lab value. Patterns of lab test ordering for PTH, phosphorus, 25D, calcium, and ALP and drug prescribing for activated vitamin D compounds, nutritional vitamin D, and phosphate binders were assessed during follow-up. We estimated the cumulative incidence of lab retesting following treatment (with death as a competing risk). We used multivariable Cox regression to examine whether pre-treatment test result values predicted retesting.

Results

We identified 215,553 stage 3, 43,576 stage 4, and 11,407 stage 5 CKD patients; mean follow-up was 2.3, 1.7, and 0.6 years, respectively. Only 46% of stage 4 and 41% of stage 5 patients underwent a PTH test; only 74% and 73%, respectively, a test for phosphorus; and only 38% and 25%, respectively, a test for 25D. By one year after treatment with activated vitamin D compounds, only 50% (stage 3), 53% (stage 4), and 60% (stage 5) of patients had received retesting for PTH [Figure]. By one year after treatment with 25D, retesting of 25D occurred in 46% (stage 3), 49% (stage 4), and 55% (stage 5) of patients by one year. Pretreatment levels of PTH and 25D were not associated in a graded fashion with retesting after treatment commenced.

Conclusion

Frequency of initial testing and retesting following treatment initiation are suboptimal. Unexpectedly, patients with the highest and lowest pre-treatment levels of PTH and 25D, respectively, did not have the highest rate of retesting, suggesting room for improvement.

Funding

  • Commercial Support