Effectiveness of a chronic kidney disease clinic in achieving K/DOQI guideline targets at initiation of dialysis--a single-centre experience.

BACKGROUND: Limited data exist about the effects of chronic kidney disease (CKD) clinics on quality-of-care indicators in patients before initiation of dialysis.
METHODS: A single-centre retrospective chart review study was conducted on all patients who initiated dialysis at the Veterans Affairs Denver Healthcare System between 2000 and 2005. Patients initiating dialysis were evaluated at the start of dialysis and 12 months after dialysis initiation, as a function of care provided by nephrologists in training (renal-hypertension clinic) vs a trained renal nurse practitioner (CKD clinic).
RESULTS: Data were available for 77 patients followed in the CKD clinic and 36 in the renal-hypertension clinic. There were no major demographic differences between the cohorts at the time of clinic referral. The length of follow-up before dialysis did not differ significantly between the cohorts (10.7+/-9.8 months for the patients in the CKD clinic cohort and 13.6+/-16.0 months for the patients in the renal-hypertension clinic cohort, P=0.3299). At the initiation of dialysis, patients followed in the CKD clinic had higher haemoglobin (11.6+/-1.5 vs 10.8+/-1.7 g/dl, P=0.0239) and serum albumin (3.4+/-0.5 vs 3.0+/-0.7 g/dl, P=0.0020) concentrations. More of the CKD clinic patients had a functioning permanent vascular access (P<0.0001). The number of all-cause hospitalizations in the 12 months after initiation of dialysis was significantly lower in the CKD clinic group (P=0.0024), but no significant differences were noted in all-cause mortality.
CONCLUSIONS: Our data indicate that a single experienced renal nurse practitioner, working to a protocol, is more likely to adhere to guidelines than are multiple nephrology trainees rotating through a nephrology clinic.