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Don’t initiate chronic dialysis without ensuring a shared decision-making process between patients, their families, and their nephrology health care team
Choosing Wisely Canada
Canadian Society of Nephrology - Canadian Medical Association - University of Toronto
The decision to initiate chronic dialysis should be part of an individualized, shared decision-making process between patients, their families, and their nephrology health care team. This process includes eliciting individual patient goals and preferences and providing information on prognosis and expected benefits and harms of dialysis within the context of these goals and preferences. Limited observational data suggest that survival may not differ substantially for older adults with a high ...
ver más ... 2014Don’t prescribe angiotensin converting enzyme (ACE) inhibitors in combination with angiotensin II receptor blockers (ARBs) for the treatment of hypertension, diabetic nephropathy and heart failure
Choosing Wisely Canada
Canadian Society of Nephrology - Canadian Medical Association - University of Toronto
For further information please visit the website of the initiative (link below)
ver más ... 2014Don’t prescribe nonsteroidal anti-inflammatory drugs (NSAIDS) in individuals with hypertension or heart failure or CKD of all causes, including diabetes
Choosing Wisely Canada
Canadian Society of Nephrology - Canadian Medical Association - University of Toronto
The use of NSAIDS, including cyclo-oxygenase type 2 (COX-2) inhibitors, for the pharmacological treatment of musculoskeletal pain can elevate blood pressure, make antihypertensive drugs less effective, cause fluid retention and worsen kidney function in these individuals. Other medication prescribed by a healthcare professional may be safer than and as effective as NSAIDs.
ver más ... 2014Don’t initiate erythropoiesis-stimulating agents (ESAs) in chronic kidney disease (CKD) patients with hemoglobin levels greater than or equal to 100 g/L without symptoms of anemia
Choosing Wisely Canada
Canadian Society of Nephrology - Canadian Medical Association - University of Toronto
Administering ESAs to CKD patients with the goal of normalizing hemoglobin levels has not demonstrated survival or cardiovascular disease benefit, and may be harmful in comparison to a treatment regimen that delays ESA administration or sets relatively conservative targets (90–110 g/L).
ver más ... 2014Don’t transfuse patients based solely on an arbitrary hemoglobin threshold
Choosing Wisely Canada
Canadian Hematology Society - Canadian Medical Association - University of Toronto
Decisions to transfuse should be based on assessment of an individual patient including their underlying cause of anemia. There is high quality evidence that demonstrates a lack of benefit and, in some cases, harm to patients transfused to achieve an arbitrary transfusion threshold. If necessary, transfuse only the minimum number of units required instead of a liberal transfusion strategy. Risks of red blood cell transfusions include allergy, fever, infections, volume overload and hemolysis.
ver más ... 2014