{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T14:07:19Z","timestamp":1740146839918,"version":"3.37.3"},"reference-count":11,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2023,3,29]],"date-time":"2023-03-29T00:00:00Z","timestamp":1680048000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100015851","name":"OPKO Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100015851","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>Little is known about the most important factors that inform a nephrologist\u2019s decision to treat (DTT) pre-dialysis chronic kidney disease (CKD) patients with vitamin D insufficiency (VDI) and secondary hyperparathyroidism (SHPT). The objective of this study was to identify such factors and their relative importance in the DTT with a vitamin D therapy. A web-based, adaptive design conjoint analysis discrete-choice survey was developed to study factors that informed the DTT among a sample of 200 nephrologists located throughout the United States. Based on literature review and clinician input, eight attributes were selected that could influence a provider\u2019s DTT: age, race, CKD stage, serum 25-hydroxyvitamin D (25D), parathyroid hormone (PTH), serum calcium (Ca), serum phosphorus (P), and history of comorbidities. Respondents were asked to select one patient profile most suitable for treatment from three profiles with varying attribute levels. Each attribute\u2019s relative importance score was computed using hierarchical-Bayesian statistics to measure the influence of each factor where higher scores represented greater DTT consideration. The pooled analysis revealed the four most important factors: serum 25D (31.4%), serum Ca (22.7%), plasma PTH (11.5%) levels, and history of comorbidities (8.5%). Age (8.2%), serum P (7.7%), CKD stage (5.7%), and race (4.4%) were relatively less important. Patients\u2019 25D and Ca levels contributed to more than half of nephrologists\u2019 DTT, with the consideration of PTH levels being less of a factor. Further understanding of the driving forces behind the factors that inform the DTT may help to standardize the management of CKD patients with SHPT and VDI and improve outcomes.<\/jats:p>","DOI":"10.1371\/journal.pone.0283531","type":"journal-article","created":{"date-parts":[[2023,3,29]],"date-time":"2023-03-29T17:51:10Z","timestamp":1680112270000},"page":"e0283531","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Factors in nephrologists\u2019 decision to treat pre-dialysis CKD patients with vitamin D insufficiency and SHPT: A discrete choice experiment"],"prefix":"10.1371","volume":"18","author":[{"given":"Anand C.","family":"Reddy","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andy","family":"Nguyen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"November 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Levin","year":"2007","journal-title":"Kidney Int"},{"key":"pone.0283531.ref002","doi-asserted-by":"crossref","first-page":"709","DOI":"10.1016\/j.autrev.2010.06.009","article-title":"Vitamin D and musculoskeletal health, cardiovascular disease, autoimmunity and cancer: Recommendations for clinical practice","volume":"9","author":"J Souberbielle","year":"2010","journal-title":"Autoimmun Rev"},{"key":"pone.0283531.ref003","doi-asserted-by":"crossref","first-page":"1870","DOI":"10.2215\/CJN.00910113","article-title":"25 (OH) vitamin D levels and renal disease progression in patients with type 2 diabetic nephropathy and blockade of the renin-angiotensin system.","volume":"8","author":"G Fernandez- Juarez","year":"2013","journal-title":"Clin J Am Soc Nephrol"},{"key":"pone.0283531.ref004","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1038\/ki.2008.501","article-title":"Vitamin D levels and patient outcome in chronic kidney disease","volume":"75","author":"P Ravani","year":"2009","journal-title":"Kidney Int"},{"key":"pone.0283531.ref005","doi-asserted-by":"crossref","first-page":"498","DOI":"10.1038\/bonekey.2013.232","article-title":"Vitamin D and chronic kidney disease-mineral bone disease (CKD-MBD).","volume":"3","author":"SU Nigwekar","year":"2014","journal-title":"Bonekey Rep."},{"key":"pone.0283531.ref006","first-page":"S1","article-title":"KDIGO clinical practice guideline for diagnosis, evaluation, prevention, and treatment of chronic kidney disease-mineral and bone disorder (CKD-MBD).","volume":"76","author":"Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Work Group.","year":"2009","journal-title":"Kidney Int"},{"key":"pone.0283531.ref007","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1016\/j.kisu.2017.04.001","article-title":"Kidney Disease Improving Global Outcomes (KDIGO) 2017 clinical practice guideline update for the diagnosis, evaluation, prevention and treatment of chronic kidney disease\u2013mineral and bone disorder (CKD-MBD)","volume":"7","year":"2017","journal-title":"Kidney Int Suppl"},{"issue":"2 Suppl 1","key":"pone.0283531.ref008","first-page":"S1","article-title":"KDOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification","volume":"39","year":"2002","journal-title":"Am J Kidney Dis"},{"key":"pone.0283531.ref009","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1159\/000499187","article-title":"Rationale for raising current clinical practice guideline target for serum 25-hydroxyvitamin D in chronic kidney disease.","volume":"49","author":"SA Strugnell","year":"2019","journal-title":"Am J Nephrol"},{"key":"pone.0283531.ref010","article-title":"Extended-release calcifediol effectively raises serum total 25-hydroxyvitamin D even in overweight nondialysis chronic kidney disease patients with secondary hyperparathyroidism.","author":"CW Bishop","year":"2022","journal-title":"Am J Nephrol"},{"key":"pone.0283531.ref011","article-title":"Evaluation of therapies for secondary hyperparathyroidism associated with vitamin D insufficiency in chronic kidney disease.","author":"SA Strugnell","year":"2023","journal-title":"Kidney Dis"}],"container-title":["PLOS 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