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Kidney Week

Abstract: PO2274

Conservative Kidney Management Practice Patterns in the United States: A CKDopps Analysis

Session Information

Category: CKD (Non-Dialysis)

  • 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

  • Scherer, Jennifer S., NYU Langone Health, New York, New York, United States
  • Muenz, Daniel G., Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Bieber, Brian, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Stengel, Benedicte, Centre de Recherche en Epidemiologie et Sante des Populations, Villejuif, Île-de-France, France
  • Masud, Tahsin, Emory University, Atlanta, Georgia, United States
  • Robinson, Bruce M., Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Pecoits-Filho, Roberto, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Goldfeld, Keith S., NYU Langone Health, New York, New York, United States
  • Chodosh, Joshua, NYU Langone Health, New York, New York, United States
  • Charytan, David M., NYU Langone Health, New York, New York, United States

Group or Team Name

  • CKDopps Investigators
Background

Conservative kidney management (CKM) of kidney failure is an important treatment option for many patients. However, its availability in the United States (US) is not well described. We describe CKM resources and provider practice patterns in US Chronic Kidney Disease (CKD) clinics.

Methods

Cross sectional analysis of provider surveys (n=22) from unique clinics in the US from the CKD Outcomes and Practice Patterns Study (CKDopps) collected between 2014-2017.

Results

Only eight (36%) providers reported involving palliative care in planning for and educating patients about kidney failure. A majority (59%) were extremely comfortable discussing CKM and nearly 100% typically discussed CKM as a treatment option. Nearly all (95%) reported their clinics had the ability to routinely deliver CKM, but only one had a CKM protocol or guideline, and none offered a specific CKM clinic. Most providers said their clinics used the word “conservative” to describe CKM, with 24% choosing “palliative” or “supportive” terminology. Regardless of involvement of PC, most providers estimated that 5% of their patients with or approaching kidney failure were managed with CKM. Patient preference, functional status, frailty, and comorbidities were the most important factors influencing provider decisions in contemplating the suitability of CKM for patients. (Figure 1)

Conclusion

Most providers report feeling comfortable discussing CKM, yet almost no clinics report resources or dedicated infrastructure for CKM delivery. Despite reported high frequency of discussing CKM, few patients were described as choosing this treatment pathway. Factors that influence consideration of CKM are consistent with elements that generally influence well-informed geriatric and end-of-life care. Efforts to improve assessment of those elements may allow for more informed recommendations of CKM.

Factors influencing providers to consider conservative kidney management

Funding

  • NIDDK Support