BioTrends Research Group, Inc. released ChartTrends®: Bone and Mineral Metabolism in Chronic Kidney Disease Non-Dialysis (CKD-ND), an annual syndicated publication based on patient and laboratory data collected from over 1,000 U.S. CKD-ND patient charts. This report both quantifies and characterizes CKD stage 3, 4 and 5 patients under the care of a nephrologist, identifying referral patterns, physician co-management, frequency of nephrology office visits, patient demographics, co-morbidities, lab values, and management of calcium, phosphorus and PTH.
ChartTrends® compare what physicians self-report about disease management to what actually happens at the patient level. This report evaluates patient characteristics that drive treatment choices (decision to treat and brand selection) of phosphate binders, nutritional vitamin D, active vitamin D and Sensipar. Moreover, it provides information on the interplay between these therapies and details about product dosing and titration, persistency, brand switching and reasons for switching.
There is a significant discrepancy between the phosphorus level at which nephrologists report initiating phosphate binders in CKD-ND patients compared to what actually happens based on audited chart figures. Over 90 percent of patients on binders are started at a phosphorus level over 4.6 mg/dL. While co-management of CKD-ND patients is common, in over 90 percent of cases, a nephrologist versus another physician type, initiates phosphate binder treatment. There are a number of patient characteristics, co-morbidities and lab values that distinguish treated versus non-treated patients; calcium levels drive the choice of a calcium versus a non-calcium based binder.
Nephrologists tend to over-report their use of nutritional vitamin D. In actuality, approximately one-third of CKD-ND patients are on nutritional vitamin D, although there is some variation by stage. The percent of patients on active vitamin D has decreased compared to prior years and for both treated and non-treated patients, a significant number of patients have PTH levels above the KDOQI target levels. Audited figures reveal that most active vitamin D treated patients are on calcitriol and approximately one-third are on Abbott's Zemplar. This report identifies a number of patient characteristics that influence which active vitamin D agent a patient is likely to be started on, and identifies triggers for brand and dose changes. While active vitamin D brand switching is relatively uncommon, dose titrations, and specifically dose increases, are more frequent.
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