Kakuya Niihata1,2, Hiroki Nishiwaki2,3, Noriaki Kurita4,5,6, Hirokazu Okada7, Shoichi Maruyama8, Ichiei Narita9, Yugo Shibagaki10, Izaya Nakaya11. 1. Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, Fukushima, Fukushima, Japan. 2. Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE), Fukushima Medical University, Fukushima, Japan. 3. Division of Nephrology, Department of Medicine, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan. 4. Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, Fukushima, Fukushima, Japan. kuritanoriaki@gmail.com. 5. Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE), Fukushima Medical University, Fukushima, Japan. kuritanoriaki@gmail.com. 6. Department of Innovative Research and Education for Clinicians and Trainees (DiRECT), Fukushima Medical University Hospital, Fukushima, Fukushima, Japan. kuritanoriaki@gmail.com. 7. Department of Nephrology, Saitama Medical University, Moroyama Town, Saitama, Japan. 8. Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan. 9. Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Niigata, Japan. 10. Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan. 11. Department of Nephrology and Rheumatology, Iwate Prefectural Central Hospital, Morioka, Iwate, Japan.
Abstract
BACKGROUND: Few good-quality clinical trials on adults with nephrotic syndrome exist. Thus, there are discrepancies between real-world practice and clinical practice guidelines. We conducted a questionnaire-based survey to investigate potential discrepancies and the factors associated with variations in clinical practice. METHODS: A questionnaire was administered electronically to all board-certified nephrologists in Japan. To examine clinical practice variations in relation to physician characteristics, we estimated the ratio of the mean duration of steroid therapy using a generalized linear model, and the odds ratio of higher level ordinal variables using an ordered logistic regression model. RESULTS: Responses of the 116 participants showed some variation for the majority of questions. Most participants (94.8%) indicated that screening for malignant tumors was "Conducted for almost all patients". The duration of steroid therapy was found to be longer among physicians seeing ≥ 30 patients with nephrotic syndrome per month, both for minimal-change disease (ratio of mean 1.69; 95% CI 1.07-2.66) and membranous nephropathy (ratio of mean 1.71; 95% CI 1.09-2.69). CONCLUSIONS: We identified practice patterns for nephrotic syndrome and discrepancies between clinical practice guidelines and actual practice. Defining the standard therapy for nephrotic syndrome may be necessary to generate high-quality evidence and develop clinical guidelines.
BACKGROUND: Few good-quality clinical trials on adults with nephrotic syndrome exist. Thus, there are discrepancies between real-world practice and clinical practice guidelines. We conducted a questionnaire-based survey to investigate potential discrepancies and the factors associated with variations in clinical practice. METHODS: A questionnaire was administered electronically to all board-certified nephrologists in Japan. To examine clinical practice variations in relation to physician characteristics, we estimated the ratio of the mean duration of steroid therapy using a generalized linear model, and the odds ratio of higher level ordinal variables using an ordered logistic regression model. RESULTS: Responses of the 116 participants showed some variation for the majority of questions. Most participants (94.8%) indicated that screening for malignant tumors was "Conducted for almost all patients". The duration of steroid therapy was found to be longer among physicians seeing ≥ 30 patients with nephrotic syndrome per month, both for minimal-change disease (ratio of mean 1.69; 95% CI 1.07-2.66) and membranous nephropathy (ratio of mean 1.71; 95% CI 1.09-2.69). CONCLUSIONS: We identified practice patterns for nephrotic syndrome and discrepancies between clinical practice guidelines and actual practice. Defining the standard therapy for nephrotic syndrome may be necessary to generate high-quality evidence and develop clinical guidelines.
Entities:
Keywords:
Guideline-practice gap; Nephrotic syndrome; Practice patterns
Authors: Johan Maertens; Simone Cesaro; Georg Maschmeyer; Hermann Einsele; J Peter Donnelly; Alexandre Alanio; Philippe M Hauser; Katrien Lagrou; Willem J G Melchers; Jannik Helweg-Larsen; Olga Matos; Stéphane Bretagne; Catherine Cordonnier Journal: J Antimicrob Chemother Date: 2016-05-12 Impact factor: 5.790
Authors: K Ishikura; M Ikeda; S Hattori; N Yoshikawa; S Sasaki; K Iijima; K Nakanishi; N Yata; M Honda Journal: Kidney Int Date: 2008-02-27 Impact factor: 10.612