Opinion Review
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Nephrol. Jan 25, 2021; 10(1): 1-7
Published online Jan 25, 2021. doi: 10.5527/wjn.v10.i1.1
Emperor’s syndrome in the COVID-19 era: Time for patient-centered nephrology?
Dimitra Bacharaki, Athanasios Diamandopoulos
Dimitra Bacharaki, Department of Nephrology, Attikon University Hospital, Chaidari 12462, Greece
Athanasios Diamandopoulos, EKPA, Louros Foundation for the History of Medicine, Chaidari 12462, Greece
Author contributions: Bacharaki D wrote the paper; Diamandopoulos A supervised the historical background.
Conflict-of-interest statement: The authors declare no conflicts of interest related to this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Dimitra Bacharaki, MD, PhD, Doctor, Department of Nephrology, Attikon University Hospital, Rimini 1, Chaidari 12462, Greece. bacharaki@gmail.com
Received: May 20, 2020
Peer-review started: May 20, 2020
First decision: June 15, 2020
Revised: October 4, 2020
Accepted: November 11, 2020
Article in press: November 11, 2020
Published online: January 25, 2021
Processing time: 247 Days and 12.5 Hours
Abstract

The coronavirus disease-19 (COVID-19) pandemic has been a wake-up call in which has forced us to react worldwide. Health policies and practices have attracted particular attention in terms of human and financial cost. Before COVID-19, chronic kidney disease was already considered a risk multiplier in patients with diabetes and hypertension, the two now being the major risk factors for COVID-19 infection and adverse outcome. In contrast to the urgent need for action, the nephrology field is considered to be in a state of stagnation regarding the management of chronic kidney disease patients who still experience unacceptably high morbidity and mortality. Ironically and paradoxically in a field lacking robust clinical trials, clinical practice is driven by guidelines-based medicine on weak evidence. The Emperor’s syndrome, referring to Hans Christian Andersen’s fairy tale, has been described in medicine as voluntary blindness to an obvious truth, being a weak evidence-based therapeutic intervention or weak health care. A promising positive example of improving heart and kidney outcomes is the emerging treatment with sodium-glucose cotransporter 2 inhibitors. COVID-19 could boost actions for patient-centered care as a positive shift in nephrology care.

Keywords: Emperor’s syndrome; Chronic kidney disease; Guidelines-based medicine; Patient-centered care; COVID-19; Evidence-based medicine

Core Tip: In chronic kidney disease mortality is still unacceptably high. Despite many “whistle-blowers” of a “naked” Emperor (healthcare, polypharmacy without robust evidence), the change in clinical practice is slow. Examples are the absence of patient participation in the decision-making process, the low percentage of peritoneal dialysis in Europe and the United States, and the lack of algorithm-based therapeutic interventions. Sodium-glucose cotransporter 2 inhibitors are a positive example of evidence-based multitask treatment. The coronavirus disease-19 pandemic is a good time for reflection and action regarding a shift to patient-centered care in nephrology.