Kidney society describes ways to eliminate wasteful tests and procedures

(Press-News.org) Washington, DC (September 13, 2012) — Earlier this year, the American Society of Nephrology (ASN), the world's leading kidney organization, joined other groups in a campaign to help health care professionals and patients avoid wasteful and sometimes harmful medical interventions. A new article in the Clinical Journal of the American Society of Nephrology (CJASN) outlines the ASN's top five recommendations for the campaign and the rationale behind them. Following these recommendations would lower costs and lead to better care for patients with kidney disease.

Unnecessary or redundant tests and procedures account for nearly one third of the medical care delivered in the United States. As part of the Choosing Wisely® campaign, nine leading national medical specialty societies each created lists of five common, but not always necessary, tests or procedures in their fields that patients and physicians should question and discuss, taking into consideration patients' preferences, needs, and overall health goals as well as the potential benefits and harms of different options.

In their CJASN article, Amy Williams, MD (Mayo Clinic) and her colleagues reveal how ASN identified its five recommendations and describe the background evidence supporting them. Each of the ASN's 10 Advisory Groups submitted recommendations, and the ASN Quality and Patient Safety Task Force, chaired by Dr. Williams, selected five based on relevance and importance to individuals with kidney disease. The ASN public policy board and council unanimously approved the final list, which includes the following: 1. Do not perform routine cancer screening for dialysis patients with limited life expectancies without signs or symptoms; 2. Do not administer erythropoiesis stimulating agents — drugs that are commonly used to treat anemia — to chronic kidney disease (CKD) patients with hemoglobin levels ≥10 g/dL without symptoms of anemia; 3. Avoid nonsteroidal anti-inflammatory drugs in individuals with hypertension, heart failure, or CKD; 4. Do not place peripherally inserted central catheters — which allows access to the blood for prolonged treatments such as long chemotherapy regimens and extended antibiotic therapy — in stage 3-5 CKD patients without consulting a kidney specialist; 5. Do not initiate long-term dialysis without ensuring a shared decision-making process between patients, their families, and their physicians.

"The goals of the Choosing Wisely campaign are aligned with the ASN's goals: to deliver safe evidence-based individualized care to all patients with kidney disease. By improving the value of the care we deliver to people with kidney disease, we will improve outcomes and decrease unnecessary healthcare costs and potentially decrease harm," said Williams.

### Study co-authors include Amy Dwyer, MD (University of Louisville); Allison Eddy, MD (British Columbia Children's Hospital); Jeffrey Fink, MD (University of Maryland); Bertrand Jaber, MD (St. Elizabeth's Medical Center); Stuart Linas, MD (University of Colorado); Beckie Michael, DO (Marlton Nephrology and Hypertension); Ann O'Hare, MD (VA Puget Sound Health Care); Heidi Schaefer, MD (Vanderbilt University); Rachel Shaffer (American Society of Nephrology); Howard Trachtman, MD (NYU Langone Medical Center); Daniel Weiner, MD (Tufts Medical Center); and Ronald Falk, MD (UNC Chapel Hill School of Medicine).

The article, entitled "Critical and Honest Conversations: The Evidence Behind the "Choosing Wisely Campaign" Recommendations by the American Society of Nephrology," will appear online at http://cjasn.asnjournals.org/ on September 13, 2012, doi: 10.2215/CJN.04970512.

Disclosures: Amy Williams, MD Research Funding: Aksys, NxStage

Ronald Falk, MD Research Funding: SQI Diagnostics

Jeffrey Fink, MD Consultancy: Amgen, Sandoz Honoraria: Amgen, Sandoz Research Funding: Amgen

Bertrand Jaber, MD Research Funding: Argutus, Sekisui Scientific Advisory Board: NxStage Medical, Inc

Stuart Linas, MD Honoraria: Astra Zeneca, Gilead, Pfizer

Ann O'Hare, MD Honoraria: UpToDate

Howard Trachtman, MD Consultancy: Optherion, Alexion Honoraria: Athena Diagnostics Research Funding: CellDex

Daniel Weiner, MD Research Funding: Keryx Scientific Advisory Board: Takeda

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Founded in 1966, and with more than 13,500 members, the American Society of Nephrology (ASN) leads the fight against kidney disease by educating health professionals, sharing new knowledge, advancing research, and advocating the highest quality care for patients.