BACKGROUND:Chronic kidney disease (CKD) is associated with increased cardiovascular risk. Here we evaluate whether strict implementation of guidelines aimed at multiple targets with the aid of nurse practitioners (NP) improves management in patients with CKD. METHODS: MASTER PLAN is a randomised controlled clinical trial, performed in nine Dutch hospitals. Patients with CKD (estimated glomerular filtration rate (eGFR) 20-70 ml÷min) were randomised to receive NP support (intervention group (IG)) or physician care (control group (CG)). Patients were followed for a median of five years. Presented data are an interim analysis on risk factor control at two-year follow-up. RESULTS: We included 788 patients (532 M, 256 F), (393 CG, 395 IG), mean (±SD ) age 59 (±13) years, eGFR 38 (±15) ml÷min÷1.73m(2), blood pressure (BP) 138 (±21)÷80 (±11) mmHg. At two years 698 patients (352 IG, 346 CG) could be analysed. IG as compared with CG had lower systolic (133 vs 135 mmHg; p= 0.04) and diastolic BP (77 vs 80 mmHg; p=0.007), LDL cholesterol (2.30 vs 2.45 mmol(-l); p= 0.03), and increased use of ACE inhibitors, statins, aspirin and vitamin D. The intervention had no effect on smoking cessation, body weight, physical activity or sodium excretion. CONCLUSION: In both groups, risk factor management improved. However, changes in BP control, lipid management and medication use were more pronounced in IG than in CG. Lifestyle interventions were not effective. Coaching by NPs thus benefits everyday care of CKD patients. Whether these changes translate into improvement in clinical endpoints remains to be established.
RCT Entities:
BACKGROUND:Chronic kidney disease (CKD) is associated with increased cardiovascular risk. Here we evaluate whether strict implementation of guidelines aimed at multiple targets with the aid of nurse practitioners (NP) improves management in patients with CKD. METHODS: MASTER PLAN is a randomised controlled clinical trial, performed in nine Dutch hospitals. Patients with CKD (estimated glomerular filtration rate (eGFR) 20-70 ml÷min) were randomised to receive NP support (intervention group (IG)) or physician care (control group (CG)). Patients were followed for a median of five years. Presented data are an interim analysis on risk factor control at two-year follow-up. RESULTS: We included 788 patients (532 M, 256 F), (393 CG, 395 IG), mean (±SD ) age 59 (±13) years, eGFR 38 (±15) ml÷min÷1.73m(2), blood pressure (BP) 138 (±21)÷80 (±11) mmHg. At two years 698 patients (352 IG, 346 CG) could be analysed. IG as compared with CG had lower systolic (133 vs 135 mmHg; p= 0.04) and diastolic BP (77 vs 80 mmHg; p=0.007), LDL cholesterol (2.30 vs 2.45 mmol(-l); p= 0.03), and increased use of ACE inhibitors, statins, aspirin and vitamin D. The intervention had no effect on smoking cessation, body weight, physical activity or sodium excretion. CONCLUSION: In both groups, risk factor management improved. However, changes in BP control, lipid management and medication use were more pronounced in IG than in CG. Lifestyle interventions were not effective. Coaching by NPs thus benefits everyday care of CKDpatients. Whether these changes translate into improvement in clinical endpoints remains to be established.
Authors: Mieke J Peeters; Arjan D van Zuilen; Jan A J G van den Brand; Michiel L Bots; Marjolijn van Buren; Marc A G J Ten Dam; Karin A H Kaasjager; Gerry Ligtenberg; Yvo W J Sijpkens; Henk E Sluiter; Peter J G van de Ven; Gerald Vervoort; Louis-Jean Vleming; Peter J Blankestijn; Jack F M Wetzels Journal: J Am Soc Nephrol Date: 2013-10-24 Impact factor: 10.121
Authors: Markus P Schneider; Silvia Hübner; Stephanie I Titze; Matthias Schmid; Jennifer Nadal; Georg Schlieper; Martin Busch; Seema Baid-Agrawal; Vera Krane; Christoph Wanner; Florian Kronenberg; Kai-Uwe Eckardt Journal: Kidney Int Date: 2015-09-02 Impact factor: 10.612
Authors: Stein I Hallan; Kunihiro Matsushita; Yingying Sang; Bakhtawar K Mahmoodi; Corri Black; Areef Ishani; Nanne Kleefstra; David Naimark; Paul Roderick; Marcello Tonelli; Jack F M Wetzels; Brad C Astor; Ron T Gansevoort; Adeera Levin; Chi-Pang Wen; Josef Coresh Journal: JAMA Date: 2012-12-12 Impact factor: 56.272