title: Physicians make different decisions from nephrologists at serum creatinine 2.0 mg/dl.
abstract: BACKGROUND
  It is very important, but not clear, how physicians differ from nephrologists in treatment of renal insufficiency.
  
  
  OBJECTIVE
  To demonstrate differences in decision-making in treatment of renal insufficiency between physicians and nephrologists.
  
  
  METHODS
  Postal questionnaire.
  
  
  METHODS
  All physicians were graduates from one medical school and certified by the Japanese Society of Internal Medicine. Nephrologists were certified by the Society and the Japanese Society of Nephrology.
  
  
  METHODS
  Questionnaires were sent to 1,395 physicians and 385 nephrologists, including audit of serum creatinine concentration that would indicate referral to nephrologist, audit of continuation of angiotensin converting enzyme inhibitor (ACEI) for a case of renal insufficiency and mild hyperkalemia due to ACEI. Outputs were proportion that selected "serum creatinine 177 micromol/l (2.0 mg/dl) and over" as a referral point to the nephrologist, and proportion that chose "suspend ACEI" for a case of renal insufficiency and mild hyperkalemia due to ACEI.
  
  
  RESULTS
  Six hundred and fourteen physicians replied (44%), and 111 certified in internal medicine were extracted from them. One hundred and eighty-six certified nephrologists replied (47%), and 114 certified in internal medicine were extracted. The proportion that chose "177 micromol/l" as a referral point to the nephrologist was 20% for physicians and 61% for nephrologists (P < 0.0001). An additional 17% of nephrologists recommended creatinine concentration below 177 micromol/l, whereas no such opinion was found among physicians. The proportion that chose "suspend ACEI" was 45% for physicians and 16% for nephrologists (P < 0.0001).
  
  
  CONCLUSIONS
  There is significant difference between decisions made by physicians and nephrologists regarding treatment for patients with serum creatinine concentration of 177 micromol/l.
authors.affiliation: Department of General Practice, School of Medicine, Jichi Medical University, 3111-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan. kaitamba@jichi.ac.jp.
authors.forename: Kaichiro
authors.initials: K
authors.lastname: Tamba
authors.affiliation: Division of Nephrology, Department of Internal Medicine, School of Medicine, Jichi Medical University, 3111-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
authors.forename: Eiji
authors.initials: E
authors.lastname: Kusano
authors.affiliation: Jichi Medical University Saitama Medical Center, 1-847 Amanuma, Ohmiya-Ku, Saitama, 330-8503, Japan.
authors.forename: Kaoru
authors.initials: K
authors.lastname: Tabei
authors.affiliation: Department of General Practice, School of Medicine, Jichi Medical University, 3111-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
authors.forename: Eiji
authors.initials: E
authors.lastname: Kajii
authors.affiliation: Division of Nephrology, Department of Internal Medicine, School of Medicine, Jichi Medical University, 3111-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Asano
mesh_terms: D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects; D003404:Creatinine / Q000097:blood*; D003657:Decision Making; D005260:Female; D006801:Humans; D006947:Hyperkalemia / Q000139:chemically induced; D007676:Kidney Failure, Chronic / Q000139:chemically induced; D008297:Male; D009398:Nephrology; D010820:Physicians; D010818:Practice Patterns, Physicians'; D012017:Referral and Consultation; D011795:Surveys and Questionnaires; D000078329:Workforce
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D003404:Creatinine