Relation between pediatric experience and treatment recommendations for children and adolescents with kidney failure.
BACKGROUND
Children and adolescent patients with renal failure are frequently cared for by adult subspecialists. While peritoneal dialysis is used in less than 17% of adults with kidney failure, it is the preferred dialysis treatment for children. National data show that 45% of children receiving dialysis are treated with peritoneal dialysis and pediatric nephrologists report its use in 65% of patients receiving dialysis. Whether differences in peritoneal dialysis use among children are due to the pediatric experience of the clinician has not been examined.


OBJECTIVE
To assess whether the pediatric experience of nephrologists directly affects treatment recommendations for children with kidney failure.


METHODS
Cross-sectional survey using 10 case vignettes per survey based on random combinations of 8 patient characteristics (age, sex, race, distance from facility, cause of renal failure, family structure, education, and compliance).


METHODS
National random sample of office-, hospital-, and academic medical center-based adult and pediatric nephrologists, stratified by geographic region and conducted June to November 1999. Of 519 eligible physicians, 316 (61%) responded, including 191 adult and 125 pediatric nephrologists.


METHODS
Treatment recommendations for peritoneal dialysis vs hemodialysis, compared based on nephrologists' pediatric experience.


RESULTS
After controlling for patient characteristics, pediatric nephrologists were 60% more likely than adult nephrologists to recommend peritoneal dialysis for identical patients (odds ratio, 1.61; 95% confidence interval, 1.35-1.92). This was true regardless of dialysis training, years in practice, practice setting, geography, or patient characteristics.


CONCLUSIONS
Our data indicate that pediatric specialization of clinicians influences treatment recommendations for children and adolescents with end-stage renal disease. Referring children to adult subspecialists may lead to differences in treatment choices and processes of care.
Furth
S L
SL
Division of Pediatric Nephrology, Department of Pediatrics, Welch Center for Prevention, Epidemiology and Clinical Research, The Johns Hopkins Medical Institutions, Baltimore, MD, USA. sfurth@jhmi.edu
Hwang
W
W
Yang
C
C
Neu
A M
AM
Fivush
B A
BA
Powe
N R
NR
D000293:Adolescent; D002648:Child; D003430:Cross-Sectional Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D016015:Logistic Models; D015999:Multivariate Analysis; D009398:Nephrology / Q000592:standards / Q000706:statistics & numerical data*; D010530:Peritoneal Dialysis / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D006435:Renal Dialysis / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D014481:United States