Practice patterns in transitioning patients from chronic kidney disease to dialysis: a survey of United States nephrologists View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2018-12

AUTHORS

Mary C. Mallappallil, Steven Fishbane, Rimda Wanchoo, Edgar Lerma, Andrea Roche-Recinos, Moro Salifu

ABSTRACT

BACKGROUND: There are no guidelines for transitioning patients from chronic kidney disease stage 5 to hemodialysis. We conducted this study to determine if there are uniform patterns in how nephrologists transition patients to dialysis. METHODS: We designed an electronic survey with 39 questions and sent it to a database of practicing nephrologists at the National Kidney Foundation. Factors that were important for transitioning a patient to hemodialysis were evaluated, including medication changes on dialysis initiation, dry weight and dialysis prescription. RESULTS: 160 US Nephrologists replied to the survey; 18% (29/160) of the responses were completed via social media sites. Prior to dialysis, 74% (118/160), prescribed furosemide and 67% (107/160) used furosemide with metolazone. Once dialysis started, only 46% (74/160) of the responders continued patients on diuretics daily. Hypertension medications prescribed in dialysis were calcium channel blockers 69% (112/160), beta blockers 36% (58/160), angiotensin converting enzyme inhibitor 32% (53/160), angiotensin receptor blocker 29% (46/160) and diuretics 25% (42/160). Once dialysis started, 68% (109/160) routinely changed medications. Most, 67% (107/160) ordered patients to avoid anti-hypertensive medications on dialysis days to allow for ultrafiltration. Dry weight was determined in the first week by 29% (46/160) and in the first month by 53% (85/160). Most, 59% (94/160) felt that multiple causes lead to hypertension. Most nephrologists would prescribe small dialyzers and a shorter period of time for the first dialysis session. CONCLUSION: The transition period to chronic hemodialysis has variations in practice patterns and may benefit from further studies to optimize clinical practice. More... »

PAGES

147

Identifiers

URI

http://scigraph.springernature.com/pub.10.1186/s12882-018-0943-0

DOI

http://dx.doi.org/10.1186/s12882-018-0943-0

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1105047749

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/29929485


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