Assessment of the Needs of Nephrology Divisions to Implement Return of Clinically Significant Research Genetic Results: A Survey of Nephrotic Syndrome Study Network (NEPTUNE) Investigators

Abstract

<b><i>Introduction:</i></b> There is an increasing need to return genetic testing results to patients with kidney disease who were first genotyped on a research basis. Operationalizing this process in nephrology clinics is challenged by a limited number of genetic providers with whom to partner and a general lack of support services for all clinicians. <b><i>Methods:</i></b> We administered a survey in March 2022 to assess the current ability and ongoing needs of nephrology divisions to return clinically significant research genetic results to patients and to implement clinical genetic testing. This survey was distributed to institutions within the Nephrotic Syndrome Study Network (NEPTUNE) as part of the planning process for return of research genetic results to participants with pathogenic variants in Mendelian nephrotic syndrome genes. <b><i>Results:</i></b> Twenty-seven of 28 sites (96%) completed the survey. 59% (<i>n</i> = 16) of sites said they could handle return of research genetic results independently, with the rest expressing hesitation about the volume and complexity of patients and the limited resources and access to genetics services. 81% (<i>n</i> = 22) of these institutions did have a genetics clinic and 26% (<i>n</i> = 7) have a nephrology genetics clinic. However, 70% (<i>n</i> = 10) of these clinics have a waiting time over 1 month. 89% of divisions (<i>n</i> = 24) were conducting genetic testing and 96% of those (<i>n</i> = 23) used a kidney multi-gene panel. In 46% of divisions (<i>n</i> = 11), nephrologists were handling logistics of obtaining genetic testing samples themselves. <b><i>Conclusion:</i></b> We identified specific areas of support needed for return of clinically significant genetic results from research studies. While the surveyed nephrologists were conducting genetic testing, there were limitations in the support services available. This survey will help guide other research studies that wish to return genetic results to participants and also highlight the need for increasing support to effectively operationalize genetic testing in nephrology clinics.