Spherix Global Insights

August 13, 2020

Primary Care Providers Report High Prevalence of Chronic Kidney Disease and Categorize It as One of the Most Challenging Conditions to Manage

An independent audit conducted by Spherix Global Insights analyzed the charts of more than 1,000 patients with moderate to severe kidney disease who had not yet been referred to a nephrologist

EXTON, Pa., August 13, 2020 /PRNewswire/ — According to the National Kidney Foundation, one in three Americans over the age of 20 (a striking 73 million people) are at increased risk for kidney disease due to high blood pressure, age, obesity and diabetes, among other factors.1 Often, it is the primary care provider (PCP) who identifies these patients and serves as the first line of care during earlier stage kidney disease. However, these providers are often ill-equipped to manage the complexity of patients with advancing kidney disease, frequently resulting in suboptimal outcomes for conditions such as renal anemia.

To better understand how PCPs are managing chronic kidney disease (CKD) patients, Spherix Global Insights collaborated with 207 PCPs to perform a retrospective chart audit of 1,009 patient records. The participating PCPs also shared feedback about their own comfort level in managing patients across the CKD spectrum.

In parallel with similar Spherix audits conducted with nephrologists over the past several years, CKD patients being followed by PCPs frequently have hypertension and Type 2 diabetes, the two leading causes of end stage renal disease whereby patients will become dialysis or transplant-dependent. This project specifically evaluated patients with moderate to severe CKD (defined as being in Stage 3, 4, or 5 and not dialysis dependent) who have not yet been referred to a nephrologist. Just under 20% of the audited patients are already in Stage 4 and 5, which is generally considered severe, and still had not yet been referred to a nephrologist.

The reasons vary; for some patients, the referral is “in process,” while others are opting for palliative care options as opposed to dialysis. Indeed, roughly one-third of the PCPs agreed with the statement, “Many patients think of nephrologists as ‘dialysis doctors’ and are reluctant to be referred,” and more than one-quarter share the sentiment, “Until a patient is severe enough to require dialysis, there is not much a nephrologist can do to manage the patient that I cannot.” Such attitudes may result in patients with progressive CKD getting to nephrologists “too late” for the specialists to change the course of the renal decline.

In fact, according to the nephrology audit conducted at the end of 2019, a whopping 35% of the CKD patients managed were referred from PCPs when eGFR was less than 30ml/min/1.73m.2 Not only are these referrals coming in much later than nephrologists would like, but seldom are patients being pharmacologically treated (other than with oral iron and nutritional vitamin D) for complications such as renal anemia, metabolic acidosis, and mineral bone disorders prior to referral. With regard to anemia in particular, more than 15% of the patients present to nephrologists with a hemoglobin level less than 10.0g/dL, and a similar percent do not even have a hemoglobin level for assessment. Despite reporting that they frequently order iron studies, the audited records – from both the PCP and nephrology audits – indicate that this rarely happens.

On a positive note, most PCPs indicate they have started to use more sodium-glucose cotransporter 2 (SGLT2) inhibitors in their diabetic patients with underlying CKD over the past year, and nearly half have also started to use SGLT2 inhibitors in non-diabetic patients with underlying CKD. Despite being the only SGLT2 inhibitor to receive FDA approval for use in diabetic kidney disease,3 Janssen’s INVOKANA is not the preferred SGLT2 inhibitor among PCPs who report that prescribing of this class is often driven by managed care edicts.

PCPs express interest in new renal therapies in development, including hypoxia-inducible factor prolyl hydroxylase inhibitors (HIF-PHI) for anemia, namely roxadustat (FibroGen/AstraZeneca/Astellas), vadadustat (Akebia/Otsuka), and daprodustat (GlaxoSmithKline), as well as novel polymer veverimer (Tricida) for metabolic acidosis. Nearly all PCPs view these products as moderate to substantial advancements over other treatment options they currently have available; however, far fewer would be comfortable initiating the products themselves, leaving a continued gap in optimal management.

As CKD continues to increase in prevalence in the US, most PCPs report that they do seek out information about CKD – often relying on online resources and nephrology colleagues. This provides a strong opportunity for biopharmaceutical companies with renal products to provide the necessary bridge of information to encourage earlier and more proactive care and referrals for CKD patients to optimize treatment and, hopefully, slow renal function declines.

About RealWorld Dynamix™
RealWorld Dynamix™: Chronic Kidney Disease PCP (US) is an independent, data-driven service unmasking real patient management patterns through annual reports based on chart audits of ~1,000 patients. The report uncovers the “why” behind treatment decisions, includes year over year trending to quantify key aspects of market evolution, and integrates specialists’ attitudinal & demographic data to highlight differences between stated and actual treatment patterns.

Other RealWorld Dynamix™ studies include: Chronic Kidney Disease (Nephrology Perspective), Dialysis, Incident Dialysis, Polycystic Kidney Disease, and Lupus Nephritis.

About Spherix Global Insights
Spherix Global Insights is a hyper-focused market intelligence firm that leverages our own independent data and expertise to provide strategic guidance so biopharma stakeholders can make decisions with confidence. We specialize in select immunology, nephrology, and neurology markets.

All company, brand or product names in this document are trademarks of their respective holders.

For more information contact:
Kristen Henn, Business Development Manager
Email: [email protected]


  1. https://www.kidney.org/professionals/physicians/pcp
  2. RealWorld Dynamix: Chronic Kidney Disease, Nephrology Perspective, 2019, Spherix Global Insights
  3. On September 30, 2019, the FDA approved INVOKANA (canagliflozin) to reduce the risk of end stage kidney disease (ESKD), worsening of kidney function, cardiovascular (CV) death, and hospitalization for heart failure in adults with type 2 diabetes and diabetic kidney disease (nephropathy) with a certain amount of protein in the urine

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