Physicians make different decisions from nephrologists at serum creatinine 2.0 mg/dl

It is very important, but not clear, how physicians differ from nephrologists in treatment of renal insufficiency.

To demonstrate differences in decision-making in treatment of renal insufficiency between physicians and nephrologists.

Postal questionnaire.

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.

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.

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).

There is significant difference between decisions made by physicians and nephrologists regarding treatment for patients with serum creatinine concentration of 177 micromol/l.