Substantial practice variation exists in the management of childhood nephrotic syndrome
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Practice variation is common for nephrotic syndrome (NS) treatment.
A cross-sectional, web-based survey on NS treatment was administered to 58 Canadian pediatric nephrologists with the aim to document existing practice variation and compare practice with the recommendations of the Kidney Disease Improving Global Outcomes Clinical Practice Guideline for NS.
Of the 58 nephrologists asked to participate in the survey, 40 (69 %) responded. Among these, 62 % prescribed initial daily glucocorticoid (GC) therapy for 6 weeks, 26 % for 4 weeks by 26 %, and 10 % prescribed ‘other’. Alternate-day GC was continued for 6 weeks by 63 % of respondents and for >6 and <6 weeks by 32 and 6 %, respectively. For biopsy-confirmed minimal change disease, 65 and 46 % of respondents chose oral cyclophosphamide for frequently relapsing and steroid-dependent phenotypes, respectively; calcineurin inhibitors or mycophenolate were the second most popular choices. Kidney biopsy was ‘always’ performed by 16, 39, and 97 % of respondents for frequently relapsing, steroid-dependent, and steroid-resistant patients, respectively. Rituximab had been administered by 60 % of respondents; 22, 56, and 72 % reported that they would consider rituximab for frequently relapsing, steroid-dependent, and steroid-resistant patients, respectively. Most notable differences between practice and Guideline recommendations were first presentation GC duration, GC-sparing agent choices in frequently relapsing and steroid-dependent patients, and biopsy practices.
There is substantial Canadian practice variation in NS treatment. Assessment of factors driving variation and strategies to implement Guideline recommendations are needed.
KeywordsCorticosteroids Calcineurin inhibitors Knowledge translation Treatment Minimal change disease Relapse Kidney biopsy
We sincerely thank all the Canadian pediatric nephrologists who completed the online survey regarding their management practices in childhood nephrotic syndrome. We gratefully acknowledge the support provided by the Canadian Kidney Knowledge Translation and Generation Network and the Canadian Association of Pediatric Nephrologists in the conduct and completion of this study.
SS received salary award support from the Kidney Research Scientist Core Education and National Training Program (Kidney Foundation of Canada, Canadian Institutes for Health Research, Canadian Society of Nephrology) and Canadian Child Health Clinician Scientist Program. MZ received salary support from the Fonds de Recherche du Québec–Santé.
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