Advanced CKD Care and Decision-Making: Which Health Care Professionals Do Patients Rely on for CKD Treatment and Advice?

Abstract Rationale & Objective Chronic kidney disease (CKD) care is often fragmented across multiple health care providers. It is unclear if patients rely mostly on their nephrologists or non-nephrologist providers for medical care, including CKD treatment and advice. Study Design Cross-sectional study Setting & Participants Adults receiving nephrology care at CKD clinics in Pennsylvania, USA Predictors Frequency, duration, and patient-centeredness (range: 1 [least] to 4 [most]) of participants' nephrology care. Outcome Participants' reliance on nephrologists, primary care providers (PCPs), or other specialists for medical care, including CKD treatment and advice. Analytical Approach Multivariable logistic regression to quantify associations between participants' reliance on their nephrologists (versus other providers) and their demographics, comorbidity, kidney function, and nephrology care. Results Among 1,412 patients in clinics targeted for the study, 676 (48%) participated. Among these, 453 (67%) were eligible for this analysis. Their mean (standard deviation) age was 71 (12) years, 59% were women, 97% were white, and 65% were retired. Participants were in nephrology care for a median [interquartile range (IQR)] of 3.8 [2.0-6.6] years and completed a median [IQR] of 4 [3-5] nephrology appointments in the past two years. Half of participants (56%) relied primarily on their nephrologists, while 23% relied on PCPs, 18% on all providers equally, and 3% on other specialists. Participants' adjusted odds of relying on their nephrologists were higher for those in nephrology care for longer (odds ratio (OR) [95% confidence interval (CI)]: 1.08 [1.02-1.15], p=0.02), those who completed more nephrology visits in the previous two years (OR [95% CI]: 1.16 [1.05-1.29], p=0.005), and those who perceived their last interaction with their nephrologists as more patient-centered (OR [95% CI]: 2.63 [1.70-4.09], p Limitations Single health-system study. Conclusions Many nephrology patients relied on non-nephrologist providers for medical care. Longitudinal, patient-centered nephrology care may encourage more patients to follow nephrologists' recommendations.