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Kidney Week

Abstract: FR-OR82

Primary Care Clinician Perspectives on APOL1 Testing for Kidney Diseases

Session Information

Category: Diversity and Equity in Kidney Health

  • 900 Diversity and Equity in Kidney Health

Authors

  • Mohottige, Dinushika, Icahn School of Medicine at Mount Sinai, New York, New York, United States
  • Negron, Rennie, Icahn School of Medicine at Mount Sinai, New York, New York, United States
  • Ramos, Michelle, Icahn School of Medicine at Mount Sinai, New York, New York, United States
  • Sabin, Tatiana, Icahn School of Medicine at Mount Sinai, New York, New York, United States
  • Gomez, Miguel, Icahn School of Medicine at Mount Sinai, New York, New York, United States
  • Horowitz, Carol Rose, Icahn School of Medicine at Mount Sinai, New York, New York, United States
Background


Black and Hispanic individuals experience a disproportionate burden of ESKD and CKD progression compared to White counterparts. These disparities are multifactorial and related to health-harming socio-contextual factors and partly explained by high-risk genetic alleles including APOL1, and gene-environment interactions. Despite the growing importance of high-quality patient-centered communication around genetic risk, little is known about the perspectives of front-line primary care physicians regarding APOL1 testing for kidney disease risk.

Methods

We conducted, recorded, and transcribed 15 semi-structured interviews in 2014-2016 with general internists and family physicians in New York, NY. Two independent trained researchers coded transcripts, modified discrepancies through consensus, and used modified grounded theory to identify themes.

Results

Interviewed clinicians had a mean age of 38 years, 10 (67%) were female, 8 (52%) self-identified their race as White, 3 (20%) as Asian, 2 (13%) as Black, and 1 (7%) self-identified as Hispanic. Participants mentioned environmental and behavioral factors as contributors to kidney risk and patients’ fear of dialysis as a primary driver of HTN-related behavioral change. Additional emergent themes included 1) desires for additional training opportunities to effectively communicate testing considerations and implications of genetic testing, including potential stigma, 2) challenges identifying individuals appropriate for testing based on race/ethnicity and other sociodemographic characteristics 3) the need for low literacy, culturally-tailored, action-oriented post-testing instructions and guidance for patients, 4) fears that APOL1 disclosure would result in fatalism and decreased engagement in health promoting behaviors, and 5) the importance of ensuring APOL1 testing discussions are attentive to patient-level barriers including racial discrimination and medical mistrust.

Conclusion

Primary care physicians describe a broad interest in clinical decision-support for APOL1 genetic testing and return of results, as well as clear guidance regarding effective communication about risk and modifiable actions to reduce risk.

Funding

  • Other NIH Support