Kidney Week

Abstract: TH-PO0558

Most Patients with KDIGO-Aligned High-Risk Kidney Disease Do Not Receive Nephrology Care: A Real-World Analysis

Session Information

• CKD: From Global Burden to Precision Care - Epidemiology, Demographics, Geographies, and Risk Factors
  October 22, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2201 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

• Shril, Shirlee, Natera Inc, Austin, Texas, United States

Shirlee Shril

• Chapman, Maksim S., Natera Inc, Austin, Texas, United States

Maksim S. Chapman

• Kaur, Navchetan, Natera Inc, Austin, Texas, United States

Navchetan Kaur, PhD

• Doud, Andrew C., Natera Inc, Austin, Texas, United States

Andrew C. Doud

• Prewett, Adam, Natera Inc, Austin, Texas, United States

Adam Prewett

• Chang, Alexander R., Geisinger Health, Danville, Pennsylvania, United States

Alexander R. Chang, MD, MS

• Bhorade, Sangeeta, Natera Inc, Austin, Texas, United States

Sangeeta Bhorade, MD

• Schneider, Ronen, Natera Inc, Austin, Texas, United States

Ronen Schneider, MD

Background

KDIGO criteria recommends timely referral to nephrology care for patients at high-risk for kidney disease, yet significant delays persist. Referrals often prioritize advanced symptoms over early diagnosis, hindering preventative efforts. Here, we analyze the frequency and timing of nephrology care for high-risk patients in routine clinical practice.

Methods

We retrospectively analyzed 540,738 patients with persistent indicators of kidney disease in a large real-world dataset within Vanderbilt University Medical Center's Synthetic Derivative database (Nashville Biosciences®). Patients were labeled as high-risk if they had at least one KDIGO-aligned high-risk criterion, including eGFR<30 mL/min/1.73m², UACR ≥300 mg/g, UPCR ≥0.5 g/g, hematuria with proteinuria, advanced CKD (stage 4–5), hereditary or structural kidney disease, recurrent nephrolithiasis, or persistent potassium abnormalities. Nephrology care was defined as any documented encounter, lab, or consultation with a nephrology provider.

Results

Of 540,738 patients, 195,932 (36.2%) met ≥1 KDIGO-aligned high-risk criteria. Of these, 63,328 (32.3%) received nephrology care (Figure). Care rates varied substantially by condition, ranging from 26.6% (hereditary or structural disease) to 78.3% (significant proteinuria). Among those receiving care after meeting criteria (n=50,815), significant delays occurred: median time to care, 149 days (IQR, 5.0-1206.0 days); mean 2.65 years. Care gaps persisted even for patients with multiple high-risk features.

Conclusion

Most KDIGO-aligned high-risk patients did not receive nephrology care, and those who did often experienced substantial delays, indicating that referrals remain reactive and misaligned with clinical risk. Encouraging earlier etiologic diagnosis, including genetic testing, could identify high-risk individuals sooner and facilitate timely, precise care.

Funding

• Commercial Support – Natera, Inc.