Practice Patterns in Transitioning Patients from Chronic Kidney Disease to Dialysis: a Survey of United States Nephrologists

Overview

Journal BMC Nephrol

Publisher Biomed Central

Specialty Nephrology

Date 2018 Jun 23

PMID 29929485

Citations 5

Authors

Mary C Mallappallil

Steven Fishbane

Rimda Wanchoo

Edgar Lerma

Andrea Roche-Recinos

Moro Salifu

Affiliations

Soon will be listed here.

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.

Citing Articles

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Safety Influencing Factors and Management Countermeasures of Patients Transferred from ICU in Transition Period Based on Intelligent Processor Three-Dimensional Quality Model.

Huang P, Zhu L, Wu Q, Hu W J Healthc Eng. 2022; 2022:1455830.

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Correlation and Diagnostic Value of Serum RBP4 and sRAGE and the Condition of Patients with Chronic Kidney Disease.

Xiong S, Qi T, Gong N, Yang C Evid Based Complement Alternat Med. 2021; 2021:6166528.

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The Pre-Dialysis Care Trajectory of Chronic Kidney Disease Patients and the Start of Dialysis in Emergency: A Mixed Method Study Protocol.

Raffray M, Bayat S, Campeon A, Laude L, Vigneau C Int J Environ Res Public Health. 2019; 16(24).

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Antihypertensive Agents in the Dialysis Patient.

Fravel M, Bald E, Fraer M Curr Hypertens Rep. 2019; 21(1):5.

PMID: 30659374 DOI: 10.1007/s11906-019-0909-z.

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