Diabetic Kidney Disease Screening and Management Practices among North American Pediatric Endocrinologists Caring for...

Assess current diabetic kidney disease (DKD) screening practices in adolescents with type 2 diabetes (T2D), identify the comfort level of pediatric endocrinologists in interpreting and treating kidney dysfunction, and investigate barriers and facilitators to implementation of estimated glomerular filtration rate (eGFR) as an adjunctive surveillance metric.

An anonymous survey was distributed via email to North American pediatric endocrinologists.

A total of 115 pediatric endocrinologists (Canada, n = 40, USA, n = 75) with mean 12.4 (SD 10.3) years in practice, largely from tertiary care centers, completed the survey. Most respondents screen for DKD at T2D diagnosis and annually thereafter. Exposure to an electronic medical record screening prompt was associated with complete adherence. Random urine albumin-to-creatinine ratio was the most common test, while most respondents never ordered an eGFR for DKD surveillance. Discomfort with eGFR interpretation was common, with only one-quarter recognizing hyperfiltration as a clinical concern. Respondents would be more likely to use eGFR if it was externally validated, endorsed by a major society, or incorporated into clinical practice guidelines, with automated electronic medical record reporting as the preferred implementation method.

Pediatric endocrinologists demonstrate fidelity to pediatric T2D DKD screening clinical practice guidelines; however, comfort with eGFR interpretation in this setting remains limited.