Implementation of a Renal Precision Medicine Program: Clinician Attitudes and Acceptance.

Katherine M Spiech,Myda Khalid,Nehal A Sheth,Ranjani N Moorthi,Karthik Kannegolla,Michael T Eadon,Victoria M Pratt,Sharon M Moe,Asif A Sharfuddin,Arjun D Sinha,David S Hains,Todd C Skaar,Kimberly S Collins,Alex M Woodcock,Purnima R Tripathy

doi:10.3390/life10040032

Katherine M Spiech, Myda Khalid + Show 13 more

Open Access

https://doi.org/10.3390/life10040032

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Journal: Life	Publication Date: Mar 26, 2020
Citations: 12	License type: CC BY 4.0

Affiliation: Indiana University – Purdue University Indianapolis

Abstract

A precision health initiative was implemented across a multi-hospital health system, wherein a panel of genetic variants was tested and utilized in the clinical care of chronic kidney disease (CKD) patients. Pharmacogenomic predictors of antihypertensive response and genomic predictors of CKD were provided to clinicians caring for nephrology patients. To assess clinician knowledge, attitudes, and willingness to act on genetic testing results, a Likert-scale survey was sent to and self-administered by these nephrology providers (N = 76). Most respondents agreed that utilizing pharmacogenomic-guided antihypertensive prescribing is valuable (4.0 ± 0.7 on a scale of 1 to 5, where 5 indicates strong agreement). However, the respondents also expressed reluctance to use genetic testing for CKD risk stratification due to a perceived lack of supporting evidence (3.2 ± 0.9). Exploratory sub-group analyses associated this reluctance with negative responses to both knowledge and attitude discipline questions, thus suggesting reduced exposure to and comfort with genetic information. Given the evolving nature of genomic implementation in clinical care, further education is warranted to help overcome these perception barriers.

Highlights

Chronic kidney disease (CKD) and essential hypertension (HTN) affect roughly 15% and 30%of the general American population respectively [1,2]
We examined whether a clinician’s propensity to act on genetic variants predicting chronic kidney disease (CKD) progression
The majority of respondents agreed that genetic profiles affect CKD progression and therapeutic drug response

Summary

Introduction

Chronic kidney disease (CKD) and essential hypertension (HTN) affect roughly 15% and 30%. Of the general American population respectively [1,2]. While CKD is often concomitant with the occurrence of HTN, not all individuals with HTN develop CKD. The gap in knowledge regarding the causes of CKD and its association with other medical conditions is being filled by emerging data on genetic determinants (which may be predictive of disease progression or therapeutic drug response) [3,4]. The perceived knowledge of, attitudes toward, and willingness to act on this genetic information are unknown among clinicians caring for nephrology patients. This study seeks to assess provider’s survey responses prior to the implementation of a broad genetic testing protocol.

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