Kidney Week

Abstract: FR-PO877

Analysis of Time to Referral and Kidney Biopsy in IgA Nephropathy in Five European Countries

Session Information

• IgA Nephropathy: Clinical, Outcomes, and Therapeutics
  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

• Csomor, Philipp, Vifor Pharma Management AG, Glattbrugg, Zurich, Switzerland

Philipp Csomor, PhD

• Weiss, Meghan, Spherix Global Insights, Exton, Pennsylvania, United States

Meghan Weiss, MBA

• Snyder, Justin, Spherix Global Insights, Exton, Pennsylvania, United States

Justin Snyder

• Santos, Lucy, Vifor Pharma Management AG, Glattbrugg, Zurich, Switzerland

Lucy Santos, PharmD

Background

IgAN is the most common form of primary glomerulonephritis globally, yet time to referral and kidney biopsy is often protracted. This study investigated real-world management of IgAN patients from referral to biopsy in five European countries using a physician questionnaire and patient chart review.

Methods

From 21 Dec 2023 to 31 Jan 2024, physicians from France, Germany, Italy, Spain and the UK completed a questionnaire on IgAN management and a patient chart audit. Physicians were required to have ≥50 CKD stage 1–4 patients, including ≥4 non-dialysis IgAN patients. Patient chart inclusion criteria included ≥13 years of age; non-dialysis IgAN; estimated glomerular filtration rate ≥15 mL/min/1.73 m².

Results

272 physicians completed the questionnaire and chart audits on 514 IgAN patients. 71% of patients were referred to their current physician by a primary care physician and 6% by another nephrologist, of which 24% of these patients were referred for specialised care. For 94% of patients, urine lab and/or blood work results triggered referral. 62% of nephrologists advocate CKD stage 1/2 as the ideal time for referral to specialised care, yet 28% of patients were perceived by their physician as being referred late or extremely late. In the UK, France and Germany, ≥60% of patients were referred to a nephrologist pre-diagnosis, compared with ≤55% in Spain and Italy. 72% of nephrologists agreed that all suspected glomerular disease patients should undergo a biopsy, and few reported having difficulties in ordering or having a biopsy performed; however, 9% of patients are presumed to have IgAN without a confirmatory biopsy. On average, patients had a kidney biopsy 4.1 months after they were referred. For patients biopsied after 6 months or more, reasons for delay included the physician’s perception that the patient was not in good enough health for the procedure and that a biopsy was not deemed clinically relevant at the time.

Conclusion

Many physicians perceive that IgAN patients are referred to them late or extremely late. Furthermore, not all suspected IgAN cases receive a timely confirmatory biopsy. This study highlights the need for earlier referrals of IgAN patients and emphasises the need for timely kidney biopsies to confirm diagnosis.

Funding

• Commercial Support – CSL Vifor