Recent years have witnessed a paradigm shift in the management of ADPKD, including novel biomarkers of disease progression such as total kidney volume (TKV), refined blood pressure (BP) targets, and repurposed drugs such as Tolvaptan. We sought to identify clinician’s familiarity with and usage of these new management tools in contemporary-real world practice.

An online survey of 20 questions was disseminated to 65 nephrologists across British Columbia. The survey consisted of multiple-choice questions regarding: clinician demographics, sources of information regarding ADPKD care, self-identified needs for optimal management of ADPKD, types of renal prognostication tools used, imaging tests and frequency of follow up imaging, blood pressure targets, and understanding of Tolvaptan utility. 

A total of 29 nephrologists (45%) completed the questionnaire with at least one respondent from each health authority. 86% of respondents are assessing risk of renal progression before GFR decline in their ADPKD patients, with a variety of tools being used. 90% of respondents obtain additional imaging after diagnosis in some or all of their ADPKD patients, and 28% report use of imaging to assess risk of renal progression. 17% respondents are confident in their ability to interpret metrics of kidney size in ADPKD. 59% of nephrologists have been approached by patients about Tolvaptan, but 69% of respondents were not confident or only somewhat confident in their ability to identify which patients would benefit from treatment with Tolvaptan. 18% of respondents use BP target of <110/75 with the remainder using higher BP targets.  The necessity for access to medications (69%) and need for clear treatment guidelines and algorithms was identified by 66% of clinicians as the greatest unmet need.

The results of this survey indicate that there is variability in practice patterns, usage and familiarity with evidence-based ADPKD management tools among clinical nephrologists. Although only a minority of clinicians are confident in their ability to use these new tools and treatments appropriately, the vast majority show interest in further education. These results identify opportunities for targeted education and tool development for standardization of care in management of ADPKD in BC.

Survey of Contemporary Management of ADPKD Highlights Need for Improved Knowledge Translation