By: Kari McCarthy, Franchise Head, Nephrology
Nearly 60% of patients with chronic kidney disease (CKD) who are managed in primary care have not been referred to a nephrologist. PCP confidence in continued primary care management appears to be a major reason.
Half of PCPs say they are managing these patients effectively on their own, while a similar proportion report that the disease is not progressing rapidly.
These findings from Spherix Global Insights’ newly fielded Patient Chart Dynamix™: CKD-ND (PCP) study point to a referral gap shaped in large part by PCPs’ assessments of disease progression and their confidence in managing CKD independently.
Future referrals may hinge more heavily on disease progression The research also reveals an important difference between what PCPs say prompted past referrals and what they expect will prompt future ones. When reflecting on referrals they have already made, PCPs attribute approximately one-third to rapid disease progression and approximately one-quarter to a specific laboratory result. When considering future referrals, however, those priorities shift sharply. Nearly three-quarters expect rapid progression to prompt referral, while only one in six anticipates relying on a specific lab result.
The data suggest that PCPs expect referral decisions to become increasingly dependent on their assessment of overall disease progression rather than a specific laboratory result.
The consequences of waiting increase with disease stage
The referral pattern is already closely tied to CKD stage. PCP-reported chart data show that only four in ten Stage 3 patients have been referred to nephrology, compared with eight in ten Stage 4 patients. If rapid progression increasingly becomes the signal to act, some patients may remain in primary care until later in the course of their disease, potentially widening an already substantial referral gap.
The clinical stakes rise alongside that delay. Hospitalization risk increases sharply by CKD stage, and nearly three in ten Stage 5 patients have already been hospitalized more than once. As referral decisions become more dependent on assessments of progression, the potential clinical cost of waiting also increases.
What the referral gap means for biopharma
For biopharmaceutical companies, the findings challenge strategies that assume referral occurs at a consistent lab-value threshold. The real pathway is less uniform. It depends on how PCPs assess progression, how confident they are in managing CKD independently, and when they believe specialist care will add value.
That makes the primary care setting an important part of understanding the CKD treatment journey, even for brands ultimately prescribed or managed by nephrologists. Brand strategy therefore needs a clear view of the decisions being made in primary care before patients reach nephrology. Otherwise, patient-finding assumptions, referral initiatives, and treatment strategies may be based on a pathway that does not reflect clinical practice.
A clearer view of both sides of the referral relationship
Spherix’s Patient Chart Dynamix™ research uses physician-reported chart-level data to examine CKD care across the referral relationship.
By showing not only which patients have been referred but also why others remain in primary care, the research helps clients distinguish the expected treatment pathway from the one patients are actually following.
To learn more about Patient Chart Dynamix™: CKD-ND (PCP) and what the findings may mean for your brand, click here.