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JAMA. 2001 Feb 28;285(8):1027-33.

Relation between pediatric experience and treatment recommendations for children and adolescents with kidney failure.

Author information

  • 1Division of Pediatric Nephrology, Department of Pediatrics, Welch Center for Prevention, Epidemiology and Clinical Research, The Johns Hopkins Medical Institutions, Baltimore, MD, USA. sfurth@jhmi.edu

Abstract

CONTEXT:

Children and adolescent patients with renal failure are frequently cared for by adult subspecialists. While peritoneal dialysis is used in less than 17% of adults with kidney failure, it is the preferred dialysis treatment for children. National data show that 45% of children receiving dialysis are treated with peritoneal dialysis and pediatric nephrologists report its use in 65% of patients receiving dialysis. Whether differences in peritoneal dialysis use among children are due to the pediatric experience of the clinician has not been examined.

OBJECTIVE:

To assess whether the pediatric experience of nephrologists directly affects treatment recommendations for children with kidney failure.

DESIGN:

Cross-sectional survey using 10 case vignettes per survey based on random combinations of 8 patient characteristics (age, sex, race, distance from facility, cause of renal failure, family structure, education, and compliance).

SETTING AND PARTICIPANTS:

National random sample of office-, hospital-, and academic medical center-based adult and pediatric nephrologists, stratified by geographic region and conducted June to November 1999. Of 519 eligible physicians, 316 (61%) responded, including 191 adult and 125 pediatric nephrologists.

MAIN OUTCOME MEASURE:

Treatment recommendations for peritoneal dialysis vs hemodialysis, compared based on nephrologists' pediatric experience.

RESULTS:

After controlling for patient characteristics, pediatric nephrologists were 60% more likely than adult nephrologists to recommend peritoneal dialysis for identical patients (odds ratio, 1.61; 95% confidence interval, 1.35-1.92). This was true regardless of dialysis training, years in practice, practice setting, geography, or patient characteristics.

CONCLUSIONS:

Our data indicate that pediatric specialization of clinicians influences treatment recommendations for children and adolescents with end-stage renal disease. Referring children to adult subspecialists may lead to differences in treatment choices and processes of care.

PMID:
11209173
[PubMed - indexed for MEDLINE]
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