Blog entry by Meguid El Nahas

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by Meguid El Nahas - Thursday, 21 August 2014, 8:01 AM
Anyone in the world

It strikes that Nephrologists are so keen to publish theat they often publish short term, incomplete, underpowered and inaccurate informations...that shape our practice.

Two recent examples, in ANCA associated systemic vasculitis (AASV):

We wre told, by teh authors of the MEPEX trial, that plasma exchange improves outcomes in AASV that is associated with advanced renal insufficiency or dialysis dependent at presentation; this was based on a 12months, underpowered study with numerous shortcomings and flaws.

THIS BECAME STANDARD PRACTICE WORLDWIDE...

Now we are told, by the same authors, in a larger study with a longer follow-up:

"...Thus, although short-term results with PLEX are encouraging, the long-term benefits remain unclear. Further research is required to determine the role of PLEX in AAV...."

http://www.ncbi.nlm.nih.gov/pubmed/23615499

IN OTHER WORDS, NO EVIDENCE THAT PLASMA EXCHANGE MAKES ANY DIFFERENCE ON PATIENTS SURVIVAL OR EVEN DIALYSIS DEPENDENCY...

Another example, from the same group of experts (EUVAS), has taught us many moons ago that in AASV maintenance therapy with Azathioprine was a good and less side effecst that cyclophopsphamide and we should switch ar 3 months after remission has been induced: CYCAZAREM study.

THIS BECAME STANDARD PRACTICE WORLDWIDE...

Now teh same authors are telling us that perhaps after all that is not the case and switching to azathioprine at 3 months may not be recommended...:

" ...It remains uncertain whether converting to azathioprine after 3-6 months of induction cyclophosphamide therapy is as effective as converting after 12 months. Outcomes are still poor for this group of patients and further research is required to determine the optimal timing of maintenance therapy...."

http://www.ncbi.nlm.nih.gov/pubmed/24970876

IN OTHER WORDS, THEY DONT KNOW....

These examples, and previous ones, I remember all too well the recommendations of Aspirin + Dipyridamole for mesangiocapillary glomerulonephritis and improved survival over 12 months...only to be proved ineffective over 3 years (Donadio et al in the 80s)...., highlight a number of trends:

1. Over eagerness to publish before being sure of the facts...

2 Publication is more important to some that patients' care...

3. Better publish a poorly documented and incomplete piece of research than wait for the more comprehensive and thorough evaluation of a given intervention...

ULTIMATELY, IT IS US JOBBING NEPHROLOGISTS WHO ARE MISLED...BUT MORE SERIOUSLY, IT IS OUR PATIENTS THAT PAY THE COST OF HASTE...AND SHORT TERMISM....

 

 

 

 
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