Chronic Kidney Disease | Current Treatment | Detailed, Expanded Analysis CKD Referrals (US)

Publish date: May 2016

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The United States has seen a dramatic rise in the prevalence of chronic kidney disease (CKD) and its sequelae—namely, diabetes and hypertension. Patients with CKD are typically co-managed by many different physician types, including nephrologists, endocrinologists, and primary care physicians (PCPs). Understanding referrals patterns between these physicians for both early- and late-stage CKD patients generates greater insight into patient management, including treatment and prescribing practices. This content stream explores how early- and late-stage CKD-ND patients are referred, co-managed, diagnosed, and treated.

Table of contents

  • Detailed, Expanded Analysis CKD Referrals (US)
    • Physician Prescribing and Referral Practices
      • Referrals Between Different Physician Specialties is a Key Component of the Management and Treatment of CKD Patients.
      • Background
        • Physicians Agree on the Leading Risk Factors for CKD Progression
      • Patient Characteristics
        • As CKD Worsens, Greater Use of Pharmacologic Treatment and Higher Rates of Comorbidities Are Reported by All Physicians
      • Treatment Practices
        • The Presence of Renal Anemia and Hyperkalemia Comorbidities in CKD Patients Drive Referrals to Nephrologists, but the Presence of DN Does Not
        • Impact of T2D on BP Medication Selection
        • Statement Agreements on Patient Management- Nephrologists
        • Statement Agreements on Patient Management- Endocrinologists
        • Statement Agreements on Patient Management- PCPs
        • Statement Agreements on Patient Management- Overall
        • Responsibility of Initiating RAAS Inhibitors for DN Patients
        • Referred Physician Type Responsible for RAAS Initiation in DN Patients
        • Responsibility of Dose Adjustments of RAAS Inhibitors for DN Patients
        • Reasons for Not Initiating/Dose Adjusting RAAS Inhibitors for DN Patients
        • Responsibility of Initiating Treatment for RA
        • Referred Physician Type Responsible for RA Treatment Initiation
        • Responsibility of Dose Adjustments of RA Treatment
        • Reasons for Not Initiating/Dose Adjusting RA Treatment- Endocrinologists
        • Reasons for Not Initiating/Dose Adjusting RA Treatment- PCPs
        • Responsibility of Initiating Treatment for Hyperkalemia
        • Referred Physician Type Responsible for Hyperkalemia Treatment
        • Responsibility of Dose Adjustments of Hyperkalemia Treatment
        • Reasons for Not Initiating/Dose Adjusting Hyperkalemia Treatment- Endocrinologists
        • Reasons for Not Initiating/Dose Adjusting Hyperkalemia Treatment- PCPs
        • Time to Treatment Start
        • Patient Share by Product
      • Diagnosis Patterns
        • Initial Diagnosis of CKD-ND
        • Other Physicians Making Diagnosis
        • Difference in Tests Used to Diagnose Early-Stage CKD
      • Persistency and Compliance
        • Patients with Poor Adherence to CKD Medications are Referred More Quickly
        • Adherence of Agents: Nephrologists
        • Adherence of Agents: Endocrinologists
        • Adherence of Agents: PCPs
        • Physician Type Spending Most Time on Adherence Education
        • Impact of Poor Adherence on Referrals: Nephrologists
        • Impact of Poor Adherence on Referrals: Endocrinologists
        • Impact of Poor Adherence on Referrals: PCPs
      • Referral Patterns
        • Referrals of CKD Patients to Endocrinologists Remain Modest Despite Rising Prevalence of DN
        • Referral by CKD Stage: Nephrologists
        • Referral by CKD Stage: Endocrinologists
        • Referral by CKD Stage: PCPs
        • Source of Patients Under Personal Care: Nephrologists
        • Percent of CKD Patients with DN Referred to Endocrinologist
        • Percent of CKD-ND Patients Seen by Other Specialties: Nephrologists
    • Physician Insight on Referral Patterns and Medical Practice
      • Drivers of Referrals Vary by Physician Type.
      • Drivers of Referrals and Treatment Selection
        • Referral Patterns Between Nephrologists, Endocrinologists, and PCPs Influence Treatment CKD Patients Receive.
        • Factors Influencing Treatment and Disease Management
        • Major Drivers of Referrals and Treatment
        • Major Obstacles of Referrals and Treatment
    • Methodology
      • Primary Market Research Methodology
    • Appendix
      • Primary Market Research

Author(s): Jihan Khan, PhD; Caitlin Koris, MSPH

Jihan Khan, is a director in the oncology team at DRG. Dr. Khan manages a team of analysts who conduct extensive primary and secondary market research on several oncology indications across the major pharmaceutical markets. She also provides sales and client support across DRG oncology products.   Previously, Dr. Khan was a principal analyst on the cardiometabolic team at DRG. Her specialties were the type 2 diabetes and renal disorders markets. Dr. Khan provided forecasts of these pharmaceutical markets by evaluating the agents in development and the changing clinical behaviors and conducting primary research with payers and physicians. Prior to joining DRG, she worked as a knowledge specialist in a company where she conducted in-depth research on products and processes for commercialization. She obtained her in organic chemistry from Brandeis University and was a postdoctoral fellow at Brigham and Women’s Hospital and Harvard Medical School.

Caitlin Koris, MSPH, is a business insights analyst on the cardiovascular, metabolic, and renal disorders team at Decision Resources Group. She has developed expertise in chronic kidney disease and related disorders such as bone and mineral metabolism, renal anemia, hyperkalemia, diabetic nephropathy, and kidney transplant. Prior to joining DRG, Caitlin was a clinical research monitor for oncology phase I and II trials. She obtained her in public health/health services research (MSPH) from Emory University, where she focused on pharmacoeconomics/outcomes research and healthcare policy. She has conducted research at the Centers for Disease Control and at the Food and Drug Administration.