Back to Search
Start Over
Substantial practice variation exists in the management of childhood nephrotic syndrome.
- Source :
-
Pediatric nephrology (Berlin, Germany) [Pediatr Nephrol] 2013 Dec; Vol. 28 (12), pp. 2289-98. Date of Electronic Publication: 2013 Aug 06. - Publication Year :
- 2013
-
Abstract
- Background: Practice variation is common for nephrotic syndrome (NS) treatment.<br />Methods: 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.<br />Results: 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.<br />Conclusions: There is substantial Canadian practice variation in NS treatment. Assessment of factors driving variation and strategies to implement Guideline recommendations are needed.
- Subjects :
- Adult
Age of Onset
Biopsy
Canada epidemiology
Child
Cross-Sectional Studies
Female
Guideline Adherence
Health Care Surveys
Humans
Internet
Male
Middle Aged
Nephrotic Syndrome diagnosis
Nephrotic Syndrome epidemiology
Practice Guidelines as Topic
Predictive Value of Tests
Recurrence
Remission Induction
Surveys and Questionnaires
Time Factors
Treatment Outcome
Immunosuppressive Agents therapeutic use
Nephrotic Syndrome drug therapy
Practice Patterns, Physicians'
Subjects
Details
- Language :
- English
- ISSN :
- 1432-198X
- Volume :
- 28
- Issue :
- 12
- Database :
- MEDLINE
- Journal :
- Pediatric nephrology (Berlin, Germany)
- Publication Type :
- Academic Journal
- Accession number :
- 23917450
- Full Text :
- https://doi.org/10.1007/s00467-013-2546-0