Physicians make different decisions from nephrologists at serum creatinine 2.0 mg/dl
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It is very important, but not clear, how physicians differ from nephrologists in treatment of renal insufficiency.
To demonstrate differences in decision-making in treatment of renal insufficiency between physicians and nephrologists.
Design of study
All physicians were graduates from one medical school and certified by the Japanese Society of Internal Medicine. Nephrologists were certified by the Society and the Japanese Society of Nephrology.
Questionnaires were sent to 1,395 physicians and 385 nephrologists, including audit of serum creatinine concentration that would indicate referral to nephrologist, audit of continuation of angiotensin converting enzyme inhibitor (ACEI) for a case of renal insufficiency and mild hyperkalemia due to ACEI. Outputs were proportion that selected “serum creatinine 177 μmol/l (2.0 mg/dl) and over” as a referral point to the nephrologist, and proportion that chose “suspend ACEI” for a case of renal insufficiency and mild hyperkalemia due to ACEI.
Six hundred and fourteen physicians replied (44%), and 111 certified in internal medicine were extracted from them. One hundred and eighty-six certified nephrologists replied (47%), and 114 certified in internal medicine were extracted. The proportion that chose “177 μmol/l” as a referral point to the nephrologist was 20% for physicians and 61% for nephrologists (P < 0.0001). An additional 17% of nephrologists recommended creatinine concentration below 177 μmol/l, whereas no such opinion was found among physicians. The proportion that chose “suspend ACEI” was 45% for physicians and 16% for nephrologists (P < 0.0001).
There is significant difference between decisions made by physicians and nephrologists regarding treatment for patients with serum creatinine concentration of 177 μmol/l.
- Nakai, S, Masakane, I, Shigematsu, T, Hamano, T, Yamagata, K, Watanabe, Y, Itami, Y, Ogata, S, Kimata, N, Shinoda, T, Shouji, T, Suzuki, K, Taniguchi, M, Tuchida, K, Nakamoto, H, Nishi, S, Nishi, H, Hashimoto, S, Hasegawa, T, Hanabusa, N, Fujii, N, Marubayashi, S, Morita, O, Wakai, T, Wada, A, Iseki, K, Tsubakihara, Y (2009) An overview of dialysis treatment in Japan (as of Dec. 31, 2007). J Jap Soc Dial Ther 42: pp. 1-45 CrossRef
- Winkelmayer, WC, Owen, WF, Levin, R, Avorn, J (2003) A propensity analysis of late versus early nephrologist referral and mortality on dialysis. J Am Soc Nephrol 14: pp. 486-492 CrossRef
- Obrador, GT, Pereira, BJ (1998) Early referral to the nephrologist and timely initiation of renal replacement therapy: a paradigm shift in the management of patients with chronic renal failure. Am J Kidney Dis 31: pp. 398-417 CrossRef
- Schmidt, RJ, Domico, JR, Sorkin, MI, Hobbs, G (1998) Early referral and its impact on emergent first dialyses, health care costs, and outcome. Am J Kidney Dis 32: pp. 278-283 CrossRef
- K/DOQI, clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 39: pp. S1-266
- Lewis, EJ, Hunsicker, LG, Bain, RP, Rohde, RD (1993) The effect of angiotensin-converting enzyme inhibition on diabetic nephropathy. N Engl J Med 329: pp. 1456-1462 CrossRef
- Gansevoort, RT, Sluiter, WJ, Hemmelder, MH, Zeeuw, D, Jong, PE (1995) Antiproteinuric effect of blood-pressure-lowering agents: a meta-analysis of comparative trials. Nephrol Dial Transplant 10: pp. 1963-1974
- Maschio, G, Alberti, D, Janin, G, Locatelli, F, Mann, JF, Motolese, M, Ponticelli, C, Ritz, E, Zucchelli, P (1996) Effect of the angiotensin-converting-enzyme inhibitor benazepril on the progression of chronic renal insufficiency. N Engl J Med 334: pp. 939-945 CrossRef
- Japanese Society for Nephrology (2007). Clinical practice guidebook for diagnosis and treatment of chronic kidney disease. Tokyo-igakusha.
- Cockcroft, DW, Gault, MH (1976) Prediction of creatinine clearance from serum creatinine. Nephron 16: pp. 31-41 CrossRef
- Kalra, PA, Kumwenda, M, MacDowall, P, Roland, MO (1999) Questionnaire study and audit of use of angiotensin converting enzyme inhibitor and monitoring in general practice: the need for guidelines to prevent renal failure. BMJ 318: pp. 234-237
- Lusignan, S, Chan, T, Stevens, P, O’Donoghue, D, Hague, N, Dzregah, B, Vlymen, J, Walker, M, Hilton, S (2005) Identifying patients with chronic kidney disease from general practice computer records. Fam Pract 22: pp. 234-241 CrossRef
- Akbari, A, Swedko, PJ, Clark, HD, Hogg, W, Lemelin, J, Magner, P, Moore, L, Ooi, D (2004) Detection of chronic kidney disease with laboratory reporting of estimated glomerular filtration rate and an educational program. Arch Intern Med 164: pp. 1788-1792 CrossRef
- Tian, S, Kusano, E, Ohara, T, Tabei, K, Itoh, Y, Kawai, T, Asano, Y (1997) Cystatin C measurement and its practical use in the patients with various renal diseases. Clin Nephrol 48: pp. 104-108
- Fliser, D, Ritz, E (2001) Serum cystatin C concentration as a marker of renal dysfunction in the elderly. Am J Kidney Dis 37: pp. 79-83
- Ichihara, K, Saito, K, Itoh, Y (2007) Sources of variation and reference intervals for serum cystatin C in a healthy Japanese adult population. Clin Chem Lab Med 45: pp. 1232-1236 CrossRef
- Physicians make different decisions from nephrologists at serum creatinine 2.0 mg/dl
Clinical and Experimental Nephrology
Volume 13, Issue 5 , pp 447-451
- Cover Date
- Print ISSN
- Online ISSN
- Springer Japan
- Additional Links
- General physician
- Serum creatinine
- Chronic kidney failure
- Industry Sectors
- Author Affiliations
- 1. Department of General Practice, School of Medicine, Jichi Medical University, 3111-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
- 2. Division of Nephrology, Department of Internal Medicine, School of Medicine, Jichi Medical University, 3111-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
- 3. Jichi Medical University Saitama Medical Center, 1-847 Amanuma, Ohmiya-Ku, Saitama, 330-8503, Japan