Author Affiliations: Division of Nephrology, Stanford University School of Medicine, Palo Alto, California.
We appreciate the comments of the letter writers, all of whom pointed toward an important, perhaps the most important, goal of earlier nephrology care, which is to slow the progression of chronic kidney disease. Our study1 was not designed to investigate this question. Furthermore, these data should not deter any clinician from timely referral to a nephrologist. Our study merely pointed toward certain trends in practice patterns that are unproven and even potentially harmful, including earlier initiation of dialysis and injudicious use of erythropoiesis-stimulating agents. These trends may actually have obscured true advances on other care domains that would otherwise have led to measurably improved outcomes. Our article should serve as a wake-up call toward more rigorous testing of any nephrology-driven interventions and focus on practices that are shown to be both safe and effective.
Winkelmayer WC, Chertow GM, Tamura MK. Impact of Nephrologic Care in the Early Management of Chronic Kidney Disease—Reply. Arch Intern Med. 2011;171(22):2066–2067. doi:10.1001/archinternmed.2011.588
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