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Kidney Week

Abstract: SA-PO945

Where Do Primary Care Physicians Fit in CKD Patient Care?

Session Information

Category: CKD (Non-Dialysis)

  • 2202 CKD (Non-Dialysis): Clinical‚ Outcomes‚ and Trials

Authors

  • Staudt, Meghan, Spherix Global Insights, Exton, Pennsylvania, United States
  • Foy, Denise, Spherix Global Insights, Exton, Pennsylvania, United States
Background

This research examines the management of patients with chronic kidney disease (CKD) who are not on dialysis by primary care physicians (PCPs) and evolving best care practices given the emergence of new treatment options to delay CKD progression.

Methods

Patient level data was collected via an online, HIPAA-compliant form during June 2020 as part of an independent, retrospective chart audit. A total of 1,009 CKD non-dialysis patient records were submitted by 207 PCPs.

Results

While 87% of PCPs express that they are comfortable treating patients with mild kidney disease (CKD Stages 1-2), the majority are not comfortable managing patients who have progressed to more severe kidney disease (CKD Stages 4-5). Comorbidities and complications that patients have as CKD progresses contribute to this sentiment.

Nearly two-thirds of PCPs agree early referral to nephrology results in better outcomes for patients with progressive renal disease; however, the referral often does not occur until patients reach CKD Stage 3, highlighting contradiction in PCP perceptions versus their actions. 75% of PCPs report they are comfortable initiating patients on an SGLT2 inhibitor, a therapy among several others proven to slow the progression of CKD, indicating there is potential to delay referral to nephrology even further.

Several factors contribute to the delayed referrals, including 28% of PCPs who believe nephrologists cannot do more than a PCP to manage a patient until their CKD is severe enough to require dialysis, and 32% who believe many patients consider nephrologists as “dialysis doctors” and are reluctant to be referred. Additionally, one-quarter of PCPs say nephrologists have a financial incentive to place patients on dialysis, which further delays referrals.

Conversely, 69% of PCPs report they have an excellent relationship with nephrologists when co-managing CKD patients. However, 24% report the wait time for a newly referred patient to see a nephrologist (when not an emergency) is very long. This compares well against rheumatology and dermatology where more than one-half of PCPs report the wait time is very long.

Conclusion

Although PCPs recognize the benefit of co-managing CKD patients with nephrologists, barriers to optimal care between physicians do exist. As PCPs adopt new therapies that delay CKD progression, there is potential for their CKD patient pool to expand and further delay referrals to nephrology.