Study Highlights Gaps in Clinical IgA Nephropathy Knowledge Among Nephrologists, PCPs

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Findings from a recent study are calling attention to notable gaps in physicians’ clinical knowledge of IgA nephropathy (IgAN), highlighting deficits among both specialists and generalists.¹

Survey results showed both nephrologists and primary care physicians frequently provided incorrect responses to questions about the pathophysiology of IgAN; emerging treatment pathways; the role of proteinuria and risk correlations to end-stage renal disease (ESRD) with IgAN; clinical use of the International IgAN Prediction Tool; and Kidney Disease Improving Global Outcomes (KDIGO) recommendations for managing IgAN.¹

“Understanding physician gaps related to IgA nephropathy can inform development of tools to improve physician knowledge and competence related to both diagnosis and treatment,” investigators wrote.¹ “Additionally, comparisons among specialists (nephrologists) and generalists (primary care physicians) can segment educational needs for combined or customized education to close identified gaps.”

A type of kidney disease caused by damage to the glomeruli, glomerulonephritis is a prominent cause of renal impairment and is estimated to be responsible for 10% to 15% of ESRD cases in the United States.² IgAN is a prevalent form of glomerulonephritis characterized by the deposition of IgA in the glomerular basement membrane, with immune-mediated damage leading to hematuria, proteinuria, and renal insufficiency.³

Until recently, the immunopathogenesis of IgAN has not been well understood, and uncertainties still remain.³ Even with recent developments in this understanding, examining shortcomings in their translation to diagnosis and treatment in clinical practice can help identify educational needs to eliminate knowledge gaps.¹

The survey instrument utilized in this study consisted of 25 multiple-choice, knowledge- and case-based questions designed to assess participants’ clinical knowledge related to IgAN. It was available online to physicians without monetary compensation or charge, and respondent confidentiality was maintained and responses were de-identified and aggregated prior to analyses.¹

Initial data collection occurred from March 16, 2023, to May 19, 2023. In total, 98 nephrologists and 57 PCPs completed the full assessment within this period.¹

Among the participating nephrologists, the greatest percentage of incorrect responses were observed for questions related to the risk of ESRD correlation to proteinuria (88%), International IgAN Prediction Tool (84%), and KDIGO recommendations for patients with IgAN at high risk of progression (70%). For PCPs, the most frequently incorrectly answered questions pertained to the pathophysiology of IgAN (82%), International IgAN Prediction Tool (79%), and the risk of ESRD correlation to proteinuria (72%).¹

Results showed nephrologists performed the best on questions regarding strategy for diagnosing IgAN (4% incorrect), initial treatment for IgAN (12% incorrect), and geographical presence of IgAN (13% incorrect). Even on their best-performing questions, PCPs still generally had greater rates of incorrect responses than nephrologists. The question topics with the lowest percentage of incorrect responses were for strategy for diagnosing IgAN (39% incorrect), independent major risk factor for IgAN (46% incorrect), and initial treatment for IgAN (51% incorrect).¹

“This assessment of physicians’ clinical knowledge yielded important insights into gaps related to IgAN,” investigators concluded.¹ “Further studies are planned to assess the effect of medical education on decreasing these clinical practice gaps.”

References:

1. Larkin, A. Assessment and comparison of physician gaps related to clinical knowledge of IgA nephropathy, Nephrology Dialysis Transplantation, Volume 39, Issue Supplement_1, May 2024, gfae069–1388–177, https://doi.org/10.1093/ndt/gfae069.1388
2. Kazi AM, Hashmi MF. Glomerulonephritis. StatPearls. June 26, 2023. Accessed June 13, 2024. https://www.ncbi.nlm.nih.gov/books/NBK560644/
3. Rout P, Limaiem F, Hashmi MF. IgA Nephropathy (Berger Disease). StatPearls. April 22, 2024. Accessed June 13, 2024. https://www.ncbi.nlm.nih.gov/books/NBK538214/