Kidney Week

Abstract: FR-PO922

Kidney Biopsy Practice Varies in the United States and Internationally

Session Information

• Glomerular Diseases: Potpourri
  October 25, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Glomerular Diseases

• 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics

Authors

• Toal, Michael, Queen's University Belfast Faculty of Medicine Health and Life Sciences, Belfast, Northern Ireland, United Kingdom

Michael Toal, MBChB

• Hill, Christopher, Belfast City Hospital, Belfast, Northern Ireland, United Kingdom

Christopher Hill, MD

• Quinn, Michael P., Queen's University Belfast Faculty of Medicine Health and Life Sciences, Belfast, Northern Ireland, United Kingdom

Michael P. Quinn, MD, MA, MBChB

• O'Neill, Ciaran, Queen's University Belfast Faculty of Medicine Health and Life Sciences, Belfast, Northern Ireland, United Kingdom

Ciaran O'Neill, PhD

• Maxwell, Alexander P., Queen's University Belfast Faculty of Medicine Health and Life Sciences, Belfast, Northern Ireland, United Kingdom

Alexander P. Maxwell, MD, PhD

Background

There is substantial variation in kidney biopsy practices between countries, however the reasons for this are unclear due to limited research.

Methods

A case-vignette questionnaire was developed. A biopsy propensity score (0-44) was generated from responses to indications and contraindications, which categorised respondents into one of five categories for instant feedback. Dissemination occurred by email, social media and the National Kidney Foundation.

Results

1181 nephrologists/fellows from 83 countries participated, making this the largest international study of kidney biopsy practice. The mean score was 24.2 (higher score=increased propensity). The US was the largest national group with 293 participants from 43 states. US mean=24.6.

A biopsy was most likely for nephrotic and nephritic syndromes and least likely in the setting of reduced kidney size. An adjusted multiple linear regression model demonstrated significantly higher scores for males, younger participants and those who performed biopsy more frequently (p=0.01). A previous severe complication (requiring intervention/death) did not affect propensity (p=0.76).

In countries with over 20 participants, the mean score ranged from 22.1 (Nigeria) to 26.9 (Mexico) (p<0.001). There were significant differences between the 18 US states with 5 or more participants (p=0.003) and mean score ranged from 20.3 (WI) to 29.2 (NJ & VA)(Fig.1). Increased propensity was demonstrated in states with higher nephrologist density and lower deprivation levels (p=0.002).

Conclusion

International and US kidney biopsy practice is highly variable. Ease of access to biopsy may influence propensity. State-level disparities could be affected by socioeconomic factors and nephrologist availability.

The significant variations in kidney biopsy practice warrants further examination, given its potential implications for timely care and resource use.

Fig. 1 Propensity score by US state