Testing Patterns for CKD-MBD Abnormalities in a Sample US Population
Introduction: Patterns of testing, treatment, and retesting following treatment for disorders of chronic kidney disease mineral bone disorder (CKD-MBD) have not been explored using a large electronic database. Methods: To determine concordance with CKD-MBD management guidelines, we used 2010 to 2019...
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| Format: | Article |
| Language: | English |
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Elsevier
2021-04-01
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| Series: | Kidney International Reports |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2468024920318702 |
| _version_ | 1818850118319734784 |
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| author | James B. Wetmore Yuanyuan Ji Akhtar Ashfaq David T. Gilbertson Nicholas S. Roetker |
| author_facet | James B. Wetmore Yuanyuan Ji Akhtar Ashfaq David T. Gilbertson Nicholas S. Roetker |
| author_sort | James B. Wetmore |
| collection | DOAJ |
| description | Introduction: Patterns of testing, treatment, and retesting following treatment for disorders of chronic kidney disease mineral bone disorder (CKD-MBD) have not been explored using a large electronic database. Methods: To determine concordance with CKD-MBD management guidelines, we used 2010 to 2019 data from an electronic health record (>50 million patients) to create cohorts of incident CKD stage 3, 4, and 5 patients using diagnosis codes and estimated glomerular filtration rates. The CKD-MBD test ordering and relevant drug prescribing were assessed during follow-up. We estimated cumulative incidence of posttreatment retesting (death as competing risk). We used multivariable Cox regression to examine baseline characteristics and pretreatment test results as predictors of retesting. Results: For 215,553 stage 3, 43,576 stage 4, and 11,407 stage 5 CKD patients, the mean follow-up was 2.3, 1.7, and 0.6 years, respectively. Only 46% of stage 4 and 41% of stage 5 patients underwent parathyroid hormone (PTH) testing, 74% and 73% had phosphorus testing, and 38% and 25% had 25D testing. By 1 year after vitamin D sterol treatment, only 50%, 53%, and 60% of stage 3, 4, and 5 patients had been retested for PTH. By 1 year after treatment with ergocalciferol or cholecalciferol, only 46%, 49%, and 55% had 25D reassessed. Pretreatment levels of PTH and 25D were not associated in a graded fashion with likelihood of retesting after treatment. Rates of retesting were not highest for patients with the highest and lowest pre-treatment PTH and 25D levels, respectively. Conclusion: Frequency of testing for CKD-MBD abnormalities and posttreatment retesting appears to be suboptimal. |
| first_indexed | 2024-12-19T06:44:03Z |
| format | Article |
| id | doaj.art-1c83fa33bf504d009d9aaf0eef89bc9c |
| institution | Directory Open Access Journal |
| issn | 2468-0249 |
| language | English |
| last_indexed | 2024-12-19T06:44:03Z |
| publishDate | 2021-04-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Kidney International Reports |
| spelling | doaj.art-1c83fa33bf504d009d9aaf0eef89bc9c2022-12-21T20:31:57ZengElsevierKidney International Reports2468-02492021-04-016411411150Testing Patterns for CKD-MBD Abnormalities in a Sample US PopulationJames B. Wetmore0Yuanyuan Ji1Akhtar Ashfaq2David T. Gilbertson3Nicholas S. Roetker4Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA; Division of Nephrology, Hennepin County Medical Center and Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA; Correspondence: James B. Wetmore, Chronic Disease Research Group, Hennepin Healthcare Research Institute, 701 Park Avenue, Suite S4.100, Minneapolis, Minnesota 55415, USA.Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USAOPKO Pharmaceuticals, Miami, FloridaChronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USAChronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USAIntroduction: Patterns of testing, treatment, and retesting following treatment for disorders of chronic kidney disease mineral bone disorder (CKD-MBD) have not been explored using a large electronic database. Methods: To determine concordance with CKD-MBD management guidelines, we used 2010 to 2019 data from an electronic health record (>50 million patients) to create cohorts of incident CKD stage 3, 4, and 5 patients using diagnosis codes and estimated glomerular filtration rates. The CKD-MBD test ordering and relevant drug prescribing were assessed during follow-up. We estimated cumulative incidence of posttreatment retesting (death as competing risk). We used multivariable Cox regression to examine baseline characteristics and pretreatment test results as predictors of retesting. Results: For 215,553 stage 3, 43,576 stage 4, and 11,407 stage 5 CKD patients, the mean follow-up was 2.3, 1.7, and 0.6 years, respectively. Only 46% of stage 4 and 41% of stage 5 patients underwent parathyroid hormone (PTH) testing, 74% and 73% had phosphorus testing, and 38% and 25% had 25D testing. By 1 year after vitamin D sterol treatment, only 50%, 53%, and 60% of stage 3, 4, and 5 patients had been retested for PTH. By 1 year after treatment with ergocalciferol or cholecalciferol, only 46%, 49%, and 55% had 25D reassessed. Pretreatment levels of PTH and 25D were not associated in a graded fashion with likelihood of retesting after treatment. Rates of retesting were not highest for patients with the highest and lowest pre-treatment PTH and 25D levels, respectively. Conclusion: Frequency of testing for CKD-MBD abnormalities and posttreatment retesting appears to be suboptimal.http://www.sciencedirect.com/science/article/pii/S2468024920318702chronic kidney diseasemineral/bone disorderparathyroid hormonephosphorus25D |
| spellingShingle | James B. Wetmore Yuanyuan Ji Akhtar Ashfaq David T. Gilbertson Nicholas S. Roetker Testing Patterns for CKD-MBD Abnormalities in a Sample US Population Kidney International Reports chronic kidney disease mineral/bone disorder parathyroid hormone phosphorus 25D |
| title | Testing Patterns for CKD-MBD Abnormalities in a Sample US Population |
| title_full | Testing Patterns for CKD-MBD Abnormalities in a Sample US Population |
| title_fullStr | Testing Patterns for CKD-MBD Abnormalities in a Sample US Population |
| title_full_unstemmed | Testing Patterns for CKD-MBD Abnormalities in a Sample US Population |
| title_short | Testing Patterns for CKD-MBD Abnormalities in a Sample US Population |
| title_sort | testing patterns for ckd mbd abnormalities in a sample us population |
| topic | chronic kidney disease mineral/bone disorder parathyroid hormone phosphorus 25D |
| url | http://www.sciencedirect.com/science/article/pii/S2468024920318702 |
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