Choosing Wisely
Purpose of review: The purpose of this review is to contribute to the Choosing Wisely Canada campaign and develop a list of 5 items for nephrology health care professionals and patients to re-evaluate based on evidence that they are overused or misused. Sources of information: A working group was fo...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
SAGE Publishing
2017-02-01
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| Series: | Canadian Journal of Kidney Health and Disease |
| Online Access: | https://doi.org/10.1177/2054358117695570 |
| _version_ | 1818255970828025856 |
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| author | Emilie Chan Brenda Hemmelgarn Scott Klarenbach Braden Manns Reem Mustafa Gihad Nesrallah Rory McQuillan |
| author_facet | Emilie Chan Brenda Hemmelgarn Scott Klarenbach Braden Manns Reem Mustafa Gihad Nesrallah Rory McQuillan |
| author_sort | Emilie Chan |
| collection | DOAJ |
| description | Purpose of review: The purpose of this review is to contribute to the Choosing Wisely Canada campaign and develop a list of 5 items for nephrology health care professionals and patients to re-evaluate based on evidence that they are overused or misused. Sources of information: A working group was formed from the Canadian Society of Nephrology (CSN) Clinical Practice Guidelines Committee. This working group sequentially used a multistage Delphi method, a survey of CSN members, a modified Delphi process, and a comprehensive literature review to determine 10 candidate items representing potentially ineffective care in nephrology. An in-person vote by CSN members at their Annual General Meeting was used to rank each item based on their relevance to and potential impact on patients with kidney disease to derive the final 5 items on the list. Key messages: One hundred thirty-four of 609 (22%) CSN members responded to the survey, from which the CSN working group identified 10 candidate-misused items. Sixty-five CSN members voted on the ranking of these items. The top 5 recommendations selected for the final list were (1) do not initiate erythropoiesis-stimulating agents in patients with chronic kidney disease (CKD) with hemoglobin levels greater than or equal to 100 g/L without symptoms of anemia; (2) do not prescribe nonsteroidal anti-inflammatory drugs for individuals with hypertension or heart failure or CKD of all causes, including diabetes; (3) do not prescribe angiotensin-converting-enzyme inhibitors in combination with angiotensin II receptor blockers for the treatment of hypertension, diabetic nephropathy or heart failure; (4) do not initiate chronic dialysis without ensuring a shared decision-making process between patients, their families, and their nephrology health care team; and (5) do not initiate dialysis in outpatients with CKD category G5-ND in the absence of clinical indications. Limitations: A low survey response rate of both community and academic nephrologists could contribute to sampling bias. However, the purpose of this report is to generate discussion, rather than study practice variation. Implications: These 5 evidence-based recommendations aim to improve outcomes and individualize care for patients with kidney disease, while reducing inefficiencies and preventing harm. |
| first_indexed | 2024-12-12T17:20:20Z |
| format | Article |
| id | doaj.art-c1754568dd0246f3ae1f4188077d7d46 |
| institution | Directory Open Access Journal |
| issn | 2054-3581 |
| language | English |
| last_indexed | 2024-12-12T17:20:20Z |
| publishDate | 2017-02-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Canadian Journal of Kidney Health and Disease |
| spelling | doaj.art-c1754568dd0246f3ae1f4188077d7d462022-12-22T00:17:41ZengSAGE PublishingCanadian Journal of Kidney Health and Disease2054-35812017-02-01410.1177/205435811769557010.1177_2054358117695570Choosing WiselyEmilie Chan0Brenda Hemmelgarn1Scott Klarenbach2Braden Manns3Reem Mustafa4Gihad Nesrallah5Rory McQuillan6University Health Network, University of Toronto, Ontario, CanadaUniversity of Calgary, Alberta, CanadaUniversity of Alberta, Edmonton, CanadaUniversity of Calgary, Alberta, CanadaDepartment of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, CanadaHumber River Regional Hospital, Weston, Ontario, CanadaUniversity Health Network, University of Toronto, Ontario, CanadaPurpose of review: The purpose of this review is to contribute to the Choosing Wisely Canada campaign and develop a list of 5 items for nephrology health care professionals and patients to re-evaluate based on evidence that they are overused or misused. Sources of information: A working group was formed from the Canadian Society of Nephrology (CSN) Clinical Practice Guidelines Committee. This working group sequentially used a multistage Delphi method, a survey of CSN members, a modified Delphi process, and a comprehensive literature review to determine 10 candidate items representing potentially ineffective care in nephrology. An in-person vote by CSN members at their Annual General Meeting was used to rank each item based on their relevance to and potential impact on patients with kidney disease to derive the final 5 items on the list. Key messages: One hundred thirty-four of 609 (22%) CSN members responded to the survey, from which the CSN working group identified 10 candidate-misused items. Sixty-five CSN members voted on the ranking of these items. The top 5 recommendations selected for the final list were (1) do not initiate erythropoiesis-stimulating agents in patients with chronic kidney disease (CKD) with hemoglobin levels greater than or equal to 100 g/L without symptoms of anemia; (2) do not prescribe nonsteroidal anti-inflammatory drugs for individuals with hypertension or heart failure or CKD of all causes, including diabetes; (3) do not prescribe angiotensin-converting-enzyme inhibitors in combination with angiotensin II receptor blockers for the treatment of hypertension, diabetic nephropathy or heart failure; (4) do not initiate chronic dialysis without ensuring a shared decision-making process between patients, their families, and their nephrology health care team; and (5) do not initiate dialysis in outpatients with CKD category G5-ND in the absence of clinical indications. Limitations: A low survey response rate of both community and academic nephrologists could contribute to sampling bias. However, the purpose of this report is to generate discussion, rather than study practice variation. Implications: These 5 evidence-based recommendations aim to improve outcomes and individualize care for patients with kidney disease, while reducing inefficiencies and preventing harm.https://doi.org/10.1177/2054358117695570 |
| spellingShingle | Emilie Chan Brenda Hemmelgarn Scott Klarenbach Braden Manns Reem Mustafa Gihad Nesrallah Rory McQuillan Choosing Wisely Canadian Journal of Kidney Health and Disease |
| title | Choosing Wisely |
| title_full | Choosing Wisely |
| title_fullStr | Choosing Wisely |
| title_full_unstemmed | Choosing Wisely |
| title_short | Choosing Wisely |
| title_sort | choosing wisely |
| url | https://doi.org/10.1177/2054358117695570 |
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