Patients with advanced vs. early CKD more likely to try new medications
Patients with chronic kidney disease are more willing to assume some risks of new medication as their disease advances, according to data published in Kidney Medicine.
Further, investigators found physicians might consider initiating risk vs. benefit conversations with patients when prescribing a new medication to slow disease progression.
“While risk prediction tools may improve selection of patients most likely to benefit from interventions that decrease the risk of CKD progression, there is still much to learn about why some patients progress and others do not, and, in the absence of precise risk estimates, patients may not be able to quantify their risk in order to weigh benefits of early treatment,” Kelli Collins Damron, MSW, from the National Kidney Foundation, and colleagues wrote. They added, “As no therapy is without side effects, it is particularly important to capture concerns regarding side effects that may have an impact on willingness to take a medication.”
In 2020, the NKF and FDA co-sponsored a scientific workshop to determine what patients consider when taking a new medication. Researchers developed an online observational survey study for the workshop that evaluated the willingness of a patient with CKD to take a new medication with potential adverse events to slow disease progression.
In November of 2020, the NKF sent the survey to its email database and posted a link to the survey online. Overall, 1,029 patients with CKD responded, 55% of which identified as being without dialysis and 26% identified as a kidney transplant recipient.
Damron and colleagues wrote, “To assess perspectives around the risks and benefits of taking a new medication, we developed scenarios that asked respondents to consider if they would take a new medication that would reduce their risk of developing kidney failure over the next 20, 10 and 5 years, framed with the assumption that they had a 20% risk of developing kidney failure over those time periods.”
Throughout the 26 questions, researchers asked patients to weigh the risks of medication adverse events on a five-point scale and to value factors of a medication as not important, important or very important.
Analyses of the results revealed patients were more likely to take a new medication that would reduce their disease progression the more advanced their kidney disease became (from 33% to 47% from 20 to 5 years). However, some patients were not willing to take the medication despite risks (12.1%, 9.7%, 11.9% with 20-, 10- and 5-year times to kidney failure, respectively).
In order of importance, patients considered the severity of known adverse events (60.6% very important), the cost or insurance (57.9% very important) and what their doctor recommends (55.4% very important) to be the most critical factors in the decision of taking a new medication. Patients were least concerned about how often they would have to take the medication.
Researchers noted that the study lacked a large population and had limited data on the patients involved.
Damron and colleagues wrote, “For this population, who are likely to have positive engagement with the health care system, physicians’ recommendations regarding therapies and input in managing potential side effects are meaningful, and developing best practices for engaging patients, transcending biases and cultural differences, and presenting risk to patients will aid in increased clinician comfort with these difficult, yet necessary, conversations.”
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