Nephrogenic systemic fibrosis: a survey of nephrologists' perceptions and practices.

Abdel-Kader K, Patel PR, Kallen AJ, Sinkowitz-Cochran RL, Bolton WK, Unruh ML
Clin J Am Soc Nephrol. 2010 5 (6): 964-71

PMID: 20299369 · PMCID: PMC2879309 · DOI:10.2215/CJN.00140110

BACKGROUND AND OBJECTIVES - Nephrogenic systemic fibrosis (NSF) is a disorder that can affect patients with renal dysfunction exposed to a gadolinium-based contrast agent (GBCA). Given the unique role nephrologists play in caring for patients at risk to develop NSF, this study surveyed their perceptions and practices regarding NSF.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS - An internet-based, cross-sectional survey of clinical nephrologists in the United States was performed. Perceptions and self-reported practices regarding NSF and local facility policies were assessed concerning GBCA use in renal dysfunction.

RESULTS - Of the 2310 eligible nephrologists e-mailed to participate in the survey, 171 (7.4%) responded. Respondents spent 85% of their time in direct patient care and 83% worked in private practice; 59% had cared for a patient with NSF. Although over 90% were aware of the morbidity and mortality associated with NSF, 31% were unaware of an association with specific GBCA brand and 50% believed chronic kidney disease stage 3 patients were at risk to develop NSF. Changes in facility policies concerning GBCA use in renal dysfunction were widespread (>90%). Most nephrologists (56%) felt that enacted policies were appropriate, yet 58% were uncertain if the changes had benefited patients.

CONCLUSIONS - These results indicate that nephrologists are generally familiar with the risk factors and consequences of NSF, but their perceptions do not always align with current evidence. Local policy changes in GBCA use are pervasive. Most nephrologists are comfortable with these policy changes but have mixed feelings regarding their effectiveness.

MeSH Terms (23)

Attitude of Health Personnel Clinical Competence Contrast Media Cross-Sectional Studies Evidence-Based Medicine Gadolinium Guideline Adherence Health Care Surveys Health Knowledge, Attitudes, Practice Humans Internet Logistic Models Nephrogenic Fibrosing Dermopathy Nephrology Outcome and Process Assessment (Health Care) Perception Practice Guidelines as Topic Practice Patterns, Physicians' Risk Assessment Risk Factors Surveys and Questionnaires Treatment Outcome United States

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