Testing Patterns for CKD-MBD Abnormalities in a Sample US Population

James B Wetmore; Yuanyuan Ji; Akhtar Ashfaq; David T Gilbertson; Nicholas S Roetker

doi:10.1016/j.ekir.2020.12.036

Testing Patterns for CKD-MBD Abnormalities in a Sample US Population

Kidney Int Rep. 2021 Jan 6;6(4):1141-1150. doi: 10.1016/j.ekir.2020.12.036. eCollection 2021 Apr.

Authors

James B Wetmore^{1

2}, Yuanyuan Ji¹, Akhtar Ashfaq³, David T Gilbertson¹, Nicholas S Roetker¹

Affiliations

¹ Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA.
² Division of Nephrology, Hennepin County Medical Center and Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA.
³ OPKO Pharmaceuticals, Miami, Florida.

Abstract

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.

Keywords: 25D; chronic kidney disease; mineral/bone disorder; parathyroid hormone; phosphorus.