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Kidney Week

Abstract: PO1368

Clinical Practice Guideline Adoption and Nephrologist Demand

Session Information

Category: Educational Research

  • 800 Educational Research

Authors

  • Lunyera, Joseph, Duke University, Durham, North Carolina, United States
  • Pivert, Kurtis, American Society of Nephrology, Washington, District of Columbia, United States
  • Sozio, Stephen M., Johns Hopkins University, Baltimore, Maryland, United States
Background

It is unknown how clinical practice guidelines (CPGs) can affect subspecialty consult (and subspecialist) demand. This study sought to quantify how nationwide adoption of a CKD evaluation and management CPG could influence consult volume, nephrologist demand, and existing geographic maldistribution of nephrologists.

Methods

We projected the volume of nephrology consults based on KDIGO’s 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease recommendations for nephrology consultation. KDIGO’s CPG recommends a nephrology consult for patients with either a) eGFR <30 ml/min/1.73 m2; b) urine ACR ≥300 mg/g; or c) eGFR <60 ml/min/1.73 m2 and/or ACR >30 mg/g and refractory hypertension (BP ≥140/90 mmHg despite ≥4 antihypertensives). We used data from the National Health and Nutrition Examination Survey (NHANES) from 2011–2016 weighted equally across three survey periods, and disaggregated data at the Census Division level to capture geographic variation in potential demand. We calculated eGFR using the CKD-EPI formula and projected KDIGO-recommended nephrology consults as number of weighted individuals per Census Division meeting KDIGO criteria. We quantified nephrologist demand as a ratio of consult volume per nephrologist at the Census Division level using data from the 2014 American Medical Association Masterfile.

Results

Projected nephrologist demand varied geographically, from 1.67% in the Middle Atlantic to 2.33% in the South Atlantic (Table 1), translating to 330–1553 consults/nephrologist if KDIGO’s CPG were implemented nationwide. Maldistribution in the Mountain (2.19 nephrologists/100K population) and West North Central (2.44) exacerbated consult demand.

Conclusion

Implementing a CKD CPG could lead to increased demand for nephrologists, which may exacerbate the suboptimal geographic distribution of kidney health specialists.

Results
Census DivisionNHANES 2011–2016 Weighted Population Meet KDIGO Criteria (Weighted Total)Meet KDIGO Criteria (%)Nephrologists (2014 AMA)Nephrologist/100K Population (2014 Census Estimate)Additional Consults Per Nephrologist
New England
29,970,615564,870.21.88%5093.461,109.76
Middle Atlantic
14,304,792239,159.21.67%1,5963.86149.85
South Atlantic
39,132,703913,497.42.33%1,8542.97492.72
East South Central
20,078,680387,114.71.93%5372.86720.88
West South Central
18,225,756411,108.82.26%1,0322.68398.36
East North Central
25,156,334453,289.01.80%1,2522.68362.05
West North Central
34,689,394699,921.92.02%5122.441,367.03
Mountain
39,604,381699,921.91.99%5072.191,553.26
Pacific
23,670,640787,504.41.87%1,3372.58330.77