This report leverages physician insights as well as patient chart data to provide the most up-to-date information about chronic kidney disease non-dialysis (CKD-ND) patient care in the US, including referral patterns, patient demographics, the use of laboratory assessments, and the use of medications. In particular, our in-depth analysis of CKD-ND medications spans a wide range of variables including product initiation, dosing, switching, and crossovers; coverage has also been expanded in 2014 to include not only erythropoiesis stimulating agents (ESAs), IV and oral iron, but also phosphate binders, vitamin D, calcimimetic, diabetic agents, as well as a new section on products in development for renal anemia. Finally, by comparing what nephrologists report about patient care to actual patient records, gaps in intended versus actual care are uncovered and opportunities for the expanded use of CKD-ND treatments become more clearly defined.
Questions Answered in This Report:
- Understand the quantification and characterization of CKD-ND patients who are under the care of a nephrologist, including topics such as length of treatment, blood transfusion rates, hospitalization rates, and laboratory testing patterns (22 unique laboratory values are assessed). This year, the majority of CKD-ND patient charts continue to have at least one primary renal anemia measure (e.g., hemoglobin, TSAT, ferritin). When are CKD-ND patients typically referred to a nephrologist and how long are they typically followed? What percentage of patients are tested at referral to a nephrologist and have been recently tested for key laboratory values? What are the average levels for each laboratory parameter? Which measures do nephrologists indicate are most important to manage (e.g., hemoglobin, TSAT, ferritin, phosphorous)?
- Understand the demographics of patients in each stage of CKD-ND treatment, including topics such as the underlying cause of kidney disease, the presence of comorbidities, other patient characteristics (e.g., ESA hyporesponders, calcification), office visits, and co-management. In 2014, our results show the rising prevalence of diabetes in the CKD-ND patient population. In addition to diabetes, are any other underlying causes of kidney disease becoming more or less common? How does the presence of comorbidities vary by CKD-ND stage?
- Understand the standard of care for CKD-ND patients within each stage, including topics such as the selection process for renal anemia medications and the percentage of patients on ESAs, oral iron and IV iron, phosphate binders, active Vitamin D, and other medications used in the CKD-ND patient population. For example, ESA treatment with oral iron is more common than treatment with IV iron in stage 3. When do nephrologists initiate the use of various renal anemia and other medications commonly used in CKD-ND treatment? How does the use of medications vary by CKD-ND stage? How has the use of individual brands changed over recent years? How common is brand switching within each drug class? Which medications are often used in combination? How do patient profiles differ for treated and untreated individuals and for other groups (e.g., patients on calcium vs. non-calcium based phosphate binders)?
- Identify gaps in physician-reported versus audited behavior by comparing self-reported survey responses with actual treatment records. For example, nephrologists significantly over-reported their use of IV iron in earlier stage patients. Which medications are often initiated later than nephrologists claim, according to patient chart information? What opportunities exist for medications to be prescribed earlier to more patients?
- Profile the patients who would be potential candidates for new products in development for the treatment of renal anemia, including FibroGen/AstraZeneca/Astellas’s roxadustat, Akebia Therapeutics’ AKB-6548, and GSK’s GSK-1278863A. Depending on the medication, respondents indicated they would consider using these new medications to varying degrees. Better efficacy than ESAs, an alternative or unique MOA, and better safety/tolerability than ESAs are the most often cited reasons for use. What other factors will promote and detract from use? Which patient characteristics (e.g., hemoglobin level) would be present in potential candidates for these new therapies?
Markets covered: United States.
Primary research: This report is based on a survey of 212 nephrologists who also provided information on 3 to 5 CKD-ND (stage 3, stage 4, or stage 5ND) patient charts.
Screening criteria: Nephrology specialists in practice for at least 2 and no more than 30 years who oversee a minimum of 100 stage 3, 4, and 5 CKD-ND patients.
Survey fielding dates: The physician surveys were conducted from July 30, 2014, through August 27, 2014. Surveys were completed over the internet. Applicable prior wave trending is provided from 2012.
Report: PowerPoint format with 213 pages of content.