Evolve ‘Top-5’ Recommendations on low-value practices in nephrology

On World Kidney Day 2021, the RACP and Evolve launched the latest Evolve ‘Top-5’ Recommendations on low-value practices in nephrology.

Kidney function and kidney disease impact human health across an array of systems and specialities. The new Evolve recommendations on low-value practices in nephrology span and interact with a wide range of conditions, populations and disciplines.

These recommendations apply to kidney function and disease in the context of patients with cardiovascular disease, paediatric urinary tract infections, diabetes and serious infections involving aerobic, Gram-negative bacteria and the bacteria that cause tuberculosis.

These systemic interactions are at the heart of these recommendations – it might appear somewhat arcane, but applies across the border to a swathe of patients.

The newest Evolve Top-5 recommendations asks clinicians:

• not to give multiple daily doses of aminoglycoside antibiotics to patients with normal and stable kidney function as the risk of toxicity is less with a single dose
• not to use oral acetylcysteine before giving radiocontrast to patients at increased risk for contrast-induced acute kidney injury
• not to give routine prophylactic antibiotics to a child after the first urinary tract infection if at low risk of recurrent urinary tract infections
• not to intensively lower HbA1C<6.5% to <8.0% in patients with early (stage 1-3) chronic kidney disease as intense lowering increased the risk of hypoglycaemia and mortality, noting that the individual target depends on factors such as severity of CKD, macrovascular complications, comorbidities, life expectancy and others
• not to prescribe aspirin therapy for primary prevention of cardiovascular disease in patients with stage 1-3 chronic kidney disease as there is no proven benefit and it is associated with increased risk of impaired haemostasis.

Dr David Tunnicliffe, Lead Fellow in the development of these recommendations on behalf of ANZSN, outlines the recommendations.

View latest recommendations

Get involved in the Evolve Policy Reference Group

If RACP Fellows and trainees want to be more involved in shaping Evolve, consider joining the Evolve Policy Reference Group. The RACP regularly consults, collaborates and partners with Fellows and trainees in the Evolve Policy Reference Group. The group plays an important role in leading and shaping Evolve to make it more relevant and fit-for-purpose. Email evolve@racp.edu.au to find out more.