Kidney Week

Abstract: PUB380

Association Between Nephrologist Training and Health Care Use in Adolescents and Young Adults with CKD

Session Information

• Publication Only

Category: CKD (Non-Dialysis)

• 2302 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

• Levy, Rebecca V., University of Rochester Medical Center, Rochester, New York, United States

Rebecca V. Levy, MBChB, MS, MSc

• Khan, Aqsa, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States

Aqsa Khan, MS

• Dickinson, Kimberley, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States

Kimberley Dickinson

• Melamed, Michal L., NYU Langone Health, New York, New York, United States

Michal L. Melamed, MD

• Denburg, Michelle, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States

Michelle Denburg, MD

Background

Adolescence and young adulthood (AYA) is a fraught period for young people with CKD, requiring healthcare transitions and eventual transfer to new health care providers. It is unknown how differences in practice patterns between internal medicine and pediatric nephrologists caring for AYA with CKD might affect health care utilization.

Methods

Using data from three PCORnet sites, we identified prevalent individuals aged 16-24 years with CKD stages 3-5. The primary exposure variable was treating physician training (medicine vs. pediatric). The primary outcome was hospitalization rate. Analysis was by unadjusted Poisson regression stratified by age (16-18, 19-21, 22-24).

Results

Black and Hispanic patients were more likely to be seen by IM nephrologists (Table 1). Patients seen by IM nephrologists were more likely to have uncontrolled high blood pressure (41% vs 26% for 19-21 year olds, p<0.001) and more advanced CKD (median eGFR 42mL/min/1.73m²) than those seen by pediatrics (median eGFR 49 mL/min/1.73m²) (p < 0.001). Older patients seen by pediatric nephrologists were less likely to use healthcare resources (Figure 1).

Conclusion

Among AYA with CKD, disparities exist in transition and transfer process. Healthcare utilization differs between provider groups; alternatively, utilization may be lower in older patients due to a failure to successfully transfer between providers.

Patient Characteristics

Incidence Rate Ratios for Healthcare Utilization of AYA with CKD by Nephrologist Training. The refence group is IM nephrologists.

Funding

• NIDDK Support

Digital Object Identifier (DOI)

• doi: 10.1681/ASN.2025xzj4qd13