Sara Rodriguez-Lopez1, Rahul Chanchlani2, Allison B Dart3, Catherine J Morgan1, Anne-Laure Lapeyraque4, James B Tee5, Anita Brobbey6, Maneka A Perinpanayagam7, Susan Samuel7, Alberto Nettel-Aguirre8. 1. Division of Nephrology, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Canada. 2. Division of Nephrology, Department of Pediatrics, McMaster Children's Hospital, McMaster University, Hamilton, Canada. 3. Division of Nephrology, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada. 4. Division of Nephrology, Pediatric Department, Sainte Justine University Hospital Center, Montreal, Canada. 5. Division of Nephrology, Department of Pediatrics, Faculty of Medicine, Dalhousie University, Halifax, Canada. 6. Department of Community Health Sciences, University of Calgary, Calgary, Canada. 7. Section of Nephrology, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada. 8. Centre for Health and Social Analytics, National Institute for Applied Statistics Research, University of Wollongong, Wollongong, Australia.
Abstract
Background: Variation in dose and duration of corticosteroids for childhood-onset steroid-sensitive nephrotic syndrome occurs worldwide, likely reflecting the evolving evidence on optimal dosing and variable severity of the disease observed between patients. We conducted a study to determine the associations between site, physician, and patient factors, and average daily corticosteroid dose and duration of therapy. Methods: Data were derived from the Canadian Childhood Nephrotic Syndrome (CHILDNEPH) Project, an observational longitudinal study from 2013 to 2019 of children with nephrotic syndrome involving pediatric nephrologists in 11 sites across Canada. The primary outcome was average daily corticosteroid dose prescribed per episode of proteinuria, reported as mg/m2 prednisone equivalents. Secondary outcome was duration of treatment for each episode of proteinuria in days. Exposure variables were categorized into site-, physician-, and patient-level variables. Results: In total, 328 children, median age at enrollment of 4.3 years old (interquartile range [IQR], 3.6), participated and were followed for a median time of 2.62 years (IQR, 2.6). The observed variability in average daily corticosteroid dose and in duration of therapy was mostly attributed to the site where the patient was treated. Accounting for between patient, physician, and site differences, average daily corticosteroid dose decreased with increasing age (beta coefficient, -0.07; 95% confidence interval [95% CI], -0.09 to -0.05], P<0.001). African and Indigenous ethnicity was associated with longer treatment duration compared with White patients (beta coefficient: African, 42.29, 95% CI, 7.85 to 76.73, P=0.02; Indigenous, 29.65, 95% CI, 2.79 to 56.52, P=0.03). Conclusions: We found practice variation with respect to corticosteroid prescriptions across 11 Canadian sites, and that variation is mostly explained at the site level. Age and ethnicity are important factors to be considered, because they are significantly associated with the average corticosteroid dose and duration of therapy.
Background: Variation in dose and duration of corticosteroids for childhood-onset steroid-sensitive nephrotic syndrome occurs worldwide, likely reflecting the evolving evidence on optimal dosing and variable severity of the disease observed between patients. We conducted a study to determine the associations between site, physician, and patient factors, and average daily corticosteroid dose and duration of therapy. Methods: Data were derived from the Canadian Childhood Nephrotic Syndrome (CHILDNEPH) Project, an observational longitudinal study from 2013 to 2019 of children with nephrotic syndrome involving pediatric nephrologists in 11 sites across Canada. The primary outcome was average daily corticosteroid dose prescribed per episode of proteinuria, reported as mg/m2 prednisone equivalents. Secondary outcome was duration of treatment for each episode of proteinuria in days. Exposure variables were categorized into site-, physician-, and patient-level variables. Results: In total, 328 children, median age at enrollment of 4.3 years old (interquartile range [IQR], 3.6), participated and were followed for a median time of 2.62 years (IQR, 2.6). The observed variability in average daily corticosteroid dose and in duration of therapy was mostly attributed to the site where the patient was treated. Accounting for between patient, physician, and site differences, average daily corticosteroid dose decreased with increasing age (beta coefficient, -0.07; 95% confidence interval [95% CI], -0.09 to -0.05], P<0.001). African and Indigenous ethnicity was associated with longer treatment duration compared with White patients (beta coefficient: African, 42.29, 95% CI, 7.85 to 76.73, P=0.02; Indigenous, 29.65, 95% CI, 2.79 to 56.52, P=0.03). Conclusions: We found practice variation with respect to corticosteroid prescriptions across 11 Canadian sites, and that variation is mostly explained at the site level. Age and ethnicity are important factors to be considered, because they are significantly associated with the average corticosteroid dose and duration of therapy.
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Authors: Susan Samuel; Catherine J Morgan; Martin Bitzan; Cherry Mammen; Allison B Dart; Braden J Manns; R Todd Alexander; Robin L Erickson; Silviu Grisaru; Andrew W Wade; Tom Blydt-Hansen; Janusz Feber; Steven Arora; Christoph Licht; Michael Zappitelli Journal: Pediatr Nephrol Date: 2013-08-06 Impact factor: 3.714
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Authors: V Phan; T Blydt-Hansen; J Feber; N Alos; S Arora; S Atkinson; L Bell; C Clarson; R Couch; E A Cummings; G Filler; R M Grant; J Grimmer; D Hebert; B Lentle; J Ma; M Matzinger; J Midgley; M Pinsk; C Rodd; N Shenouda; R Stein; D Stephure; S Taback; K Williams; F Rauch; K Siminoski; L M Ward Journal: Osteoporos Int Date: 2013-08-16 Impact factor: 4.507
Authors: Susan Samuel; Shannon Scott; Catherine Morgan; Allison Dart; Cherry Mammen; Rulan Parekh; Alberto Nettel-Aguirre; Allison Eddy; Rachel Flynn; Maury Pinsk; Andrew Wade; Steven Arora; Geneviève Benoit; Martin Bitzan; Robin Erickson; Janusz Feber; Guido Filler; Pavel Geier; Colette Girardin; Silviu Grisaru; James Tee; Kyle Kemp; Michael Zappitelli Journal: Can J Kidney Health Dis Date: 2014-07-22