Relation between pediatric experience and treatment recommendations for children and adolescents with kidney failure

Context Children and adolescent patients with renal failure are frequently cared for by adult subspecialists, While peritoneal dialysis is used in les s than 17% of adults with kidney failure, it is the preferred dialysis trea tment for children. National data show that 45% of children receiving dialy sis are treated with peritoneal dialysis and pediatric nephrologists report its use in 65% of patients receiving dialysis. Whether differences in peri toneal dialysis use among children are due to the pediatric experience of t he clinician has not been examined. Objective To assess whether the pediatric experience of nephrologists direc tly affects treatment recommendations for children with kidney failure. Design Cross-sectional survey using 10 case vignettes per survey based on r andom combinations of 8 patient characteristics (age, sex, race, distance f rom facility, cause of renal failure, family structure, education, and comp liance). Setting and Participants 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 neph rologists. Main Outcome Measure Treatment recommendations for peritoneal dialysis vs h emodialysis, compared based on nephrologists' pediatric experience. Results After controlling for patient characteristics, pediatric nephrologi sts were 60% more likely than adult nephrologists to recommend peritoneal d ialysis for identical patients (odds ratio, 1.61; 95% confidence interval, 1.35-1.92). This was true regardless of dialysis training, years in practic e, practice setting, geography, or patient characteristics. Conclusions Our data indicate that pediatric specialization of clinicians i nfluences treatment recommendations for children and adolescents with end-s tage renal disease. Referring children to adult subspecialists may lead to differences in treatment choices and processes of care.