Conservative Kidney Management Practice Patterns and Resources in the United States: A Cross-Sectional Analysis of CKDopps (Chronic Kidney Disease Outcomes and Practice Patterns Study) Data

• Type of Material: Article
• Authors: Jennifer S. Scherer, New York University; Brian Bieber, Arbor Research Collaborative for Health; Natalia Alencar de Pinho, Université Paris Saclay; Tahsin Masud, Emory University; Bruce Robinson, University of Michigan; Roberto Pecoits-Filho, Arbor Research Collaborative for Health; Joy Schiedell, New York University; Keith Goldfeld, New York University; Joshua Chodosh, New York University; David M. Charytan, New York University
• Language: English
• Date: 2023-09-17
• Publisher: Elsevier
• Publication Version: Final Published Version
• Copyright Statement: 2023 The Authors. Published by Elsevier Inc. on behalf of the National Kidney Foundation, Inc.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): https://doi.org/10.1016/j.xkme.2023.100726
• Title of Journal or Parent Work: Kidney Medicine
• Volume: 5
• Issue: 11
• Start Page: 100726
• Grant/Funding Information: Global support for the ongoing DOPPS (Disease Outcomes and Practice Patterns Study) Programs is provided without restriction on publications by a variety of funders. Funding is provided to Arbor Research Collaborative for Health and not to Dr. Pecoits-Filho directly. Dr Scherer is supported by the NIDDK K23DK125840.
• Keywords: Conservative kidney management; practice patterns; resources
• Research Categories: Health Sciences, Health Care Management; Health Sciences, General

Abstract

Rationale & Objective Conservative kidney management (CKM) is a viable treatment option for many patients with chronic kidney disease. However, CKM practices and resources in the United States are not well described. We undertook this study to gain a better understanding of factors influencing uptake of CKM by describing: (1) characteristics of patients who choose CKM, (2) provider practice patterns relevant to CKM, and (3) CKM resources available to providers. Study Design Cross-sectional study. Setting & Participants This study is a cross-sectional analysis of data from US nephrology clinics enrolled in the chronic kidney disease Outcomes and Practice Patterns Study (CKDopps) collected between 2014 and 2020. Data for this study includes chart-abstracted characteristics of patients with an estimated glomerular filtration rate ≤30mL/min/1.73m2 (n=1018) and available information on whether a decision had been made to pursue CKM at the time of kidney failure, patient (n=407) reports of discussions about forgoing dialysis, and provider (n=26) responses about CKM delivery and available resources in their health systems. Analytical Approach Descriptive statistics were used to report patient demographics, clinical information, provider demographics, and clinic characteristics. Results Among data from 1018 patients, 68 (7%) were recorded as planning for CKM. These patients were older, had more comorbidities, and were more likely to require assistance with transfers. Of the 407 patient surveys, 18% reported a conversation about forgoing dialysis with their nephrologist. A majority of providers felt comfortable discussing CKM; however, no clinics had a dedicated clinic or protocol for CKM. Limitations Inconsistent survey terminology and unlinked patient and provider responses. Conclusions Few patients reported discussion of forgoing dialysis with their providers and even fewer anticipated a choice of CKM on reaching kidney failure. Most providers were comfortable discussing CKM, but practiced in clinics that lacked dedicated resources. Further research is needed to improve the implementation of a CKM pathway. Plain-Language Summary For older comorbid adults with kidney failure, conservative kidney management (CKM) can be an appropriate treatment choice. CKM is a holistic approach with treatment goals of maximizing quality of life and preventing progression of chronic kidney disease (CKD) without initiation of dialysis. We investigated US CKM practices and found that among 1018 people with CKD, only 7% were planning for CKM. Of 407 surveyed patients, 18% reported a conversation with their provider about forgoing dialysis. In contrast, most providers felt comfortable discussing CKM; however, none reported working in an environment with a dedicated CKM clinic or protocol. Our data show the need for further CKM education in the United States as well as dedicated resources for its delivery.