Timing of Nephrologist Care in Patients with Newly Diagnosed ADPKD

NKF Spring Clinical Meetings 2021

The most common genetic cause of end-stage kidney disease is autosomal dominant polycystic kidney disease (ADPKD). Favorable outcomes, including improved quality of life and reduction in decline in kidney function, are associated with earlier disease management by nephrologists in the course of kidney disease. Erin Hulbert, MS, and colleagues conducted a study to examine timing of nephrology care in a sample of patients with ADPKD.

Results of the study were reported during a virtual poster session at the NKF 2021 Spring Clinical Meetings. The poster was titled Delay in First Nephrologist Visit among Newly Diagnosed ADPKD Patients.

The researchers utilized the Optum Research Database to identify commercial and Medicare Advantage with Part D (MAPD) enrollees newly diagnosed with ADPKD. The index date was the first diagnosis of ADPKD from January 2007 to August 2017. Patients were enrolled during 6-month baseline and 2-year follow-up periods. International Classification of Diseases, Tenth Revision codes were used to determine chronic kidney disease (CKD) status and estimated glomerular filtration rate laboratory results.

The cohort included 4248 patients newly diagnosed with ADPKD. Of those, 51% were female, 25% were insured via MAPD, and mean age was 52 years. Thirty percent of the cohort had evidence of CKD stage 3-5 at the index date. Forty-eight percent had a visit with a nephrologist in the baseline period (21%) or on the index date (27%). Twenty-five percent had a nephrologist visit during follow-up.

A total of 1141 patients (27%) did not see a nephrologist within 2 years of the initial diagnosis of ADPKD. Of those, 157 (14%) had known CKD stage 3-5 at index. Patients had mean 8.0 baseline ambulatory visits. Forty-two percent had a baseline diagnosis for hypertension, 10% for cardiovascular complications, 12% for diabetes, 6% for kidney function, and 15% for abdominal pain.

There were no significant differences in comorbidities between patients with and patients without a nephrology visit. At the end of the study period, 31% of patients who did not have a nephrology visit had evidence of progression of CKD.

In conclusion, the researchers said, “These results provide new insight into ADPKD patients with delayed referral to specialist care. Many patients had high healthcare utilization as well as comorbidities with potential to increase risk of CKD progression. Earlier specialist monitoring and intervention may  help better manage disease complications and slow disease progression.”

Source: Hulbert E, Sanon M, Willey C, Korrer S, Wang S, Seliger S. Delay in first nephrologist visit among newly diagnosed ADPKD patients. Abstract of a poster presented at the National Kidney Foundation virtual Spring Clinical Meetings 2021 (Abstract #308), April 9, 2021.