Substantial variability in kidney biopsy decisions, established guidelines needed
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When asked how the decision to perform a kidney biopsy was determined, nephrologists responded with substantial variability. According to data published in Kidney Medicine, several factors go into the decision.
Previous studies have shown biopsies can be critical for the correct treatment of patients, but there are no widely used formal guidelines for biopsy.
In a qualitative study, Afolarin Amodu, MD, MPH, nephrologist at Boston Medical Center, and colleagues investigated the contemporary clinical decision-making among nephrologists regarding the decision to perform native kidney biopsy.
Researchers interviewed 20 nephrologists; 16 from academic centers, three performed their own biopsies and seven had been in practice for less than 10 years. All nephrologists were chosen with purposive sampling from different regions of the United States.
Using semi-structured interviews and open-ended questions, researchers explored the ways that nephrologists weigh clinical indications for kidney biopsy and their opinions about patient engagement in the decision-making. Nephrologists were asked to reflect on how their clinical experiences with biopsy could have impacted their practice patterns. All interviews occurred between September 2018 and October 2019.
Following the interviews, researchers found substantial variability in the way nephrologists felt about using kidney biopsy, which came down to individual differences in weighing the risks vs. benefits of the procedure for patients.
According to the study, these differences were explained by the following five main themes: comfort with biopsy and availability of interventional radiology for the procedure; experience with biopsy; concerns about biopsy risks including patient characteristics and preference; and perception of inadequate evidence base.
Limitations of this study included generalizability because the nephrologists sampled may not be broadly representative.
“We found that the biopsy decision is complex and that multiple factors inform the decision to biopsy including nephrologist’s experience with the biopsy procedure, nephrologists’ varying perspectives on indications, the ease of scheduling biopsies, and patient preference,” Amodu and colleagues wrote. “Development of consensus guidelines may assist nephrologists in making complex clinical decisions that balance risks and benefits.”
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Amodu A, et al. Kidney Med. 2021;doi:10.1016/j.xkme.2021.06.014.
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