Q: 56 years old male with Adult Polycystic Kidney Disease (APKD), and at the level of Chronic Kidney Disease 5 (CKD-5) is admitted to ICU with sepsis due to acute cholecystitis. Fortunately, patient is recovering without any compromise on his baseline kidney function and urine output. The nephrology fellow indicated starting hemodialysis, but the nephrology attending overrides the fellow's decision and decided to continue to watch. Less experienced nephrologists tend to start dialysis for chronic kidney insufficiency earlier than experienced nephrologists.
A) True
B) False
Answer: A
The objective of the question is to highlight the fact that the timing to start dialysis in chronic kidney patients is quite complicated. The attitude of the nephrologist, experience, nature of the practice, US vs non-US graduation, region of practice, institutional culture, and employment status play a significant role.
For example, a massive retrospective study of about 83,000 patients published in 2014 showed that physician graduation from nondomestic medical schools may factor in this matter. Experienced nephrologists may wait longer. Also, another study that looked into data spanning over 9 years found that salaried nephrologists at Veterans Affairs (VA) facilities are less likely to initiate dialysis among patients with an eGFR ≥10 mL/min/1.73 m2 compared with non-VA nephrologists.
#nephrology
References:
1. Slinin Y, Guo H, Li S, et al. Provider and care characteristics associated with timing of dialysis initiation. Clin J Am Soc Nephrol 2014; 9:310.
2. Yu MK, O'Hare AM, Batten A, et al. Trends in Timing of Dialysis Initiation within Versus Outside the Department of Veterans Affairs. Clin J Am Soc Nephrol 2015; 10:1418.
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