Sophie Abgrall1, Antoine Rachas2, Jérome Tourret3, Corinne Isnard-Bagnis4, Eric Billaud5, Pierre Tattevin6, Dominique Costagliola7, Marguerite Guiguet7, Pierre Durieux2. 1. Sorbonne Universités, UPMC Université Paris 06 INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris AP-HP, Hôpital Antoine Béclère, Service de Médecine Interne, Clamart Paris-Sud 11 University, Le Kremlin-Bicêtre. 2. Paris Descartes University, Hôpital Européen Georges Pompidou INSERM UMRS 872 eq22. 3. Urology, Nephrology and Transplantation Department, Pitie-Salpetriere Hospital UPMC Paris Université 06. 4. Urology, Nephrology and Transplantation Department, Pitie-Salpetriere Hospital UPMC Paris Université 06 Chaire de recherche en éducation thérapeutique CNAM-EHESS, Paris. 5. Hôtel-Dieu Universitary Hospital, Infectious Diseases Unit, Nantes. 6. Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France. 7. Sorbonne Universités, UPMC Université Paris 06 INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris.
Abstract
BACKGROUND:Chronic kidney disease (CKD) is frequent in individuals infected with human immunodeficiency virus (HIV). Progression to end-stage renal disease can be slowed by appropriate medical management. METHODS: To assess whether active promotion of guidelines improves CKD management, we conducted a cluster randomized controlled trial within the French Hospital Database on HIV (FHDH-ANRS CO4). We randomized 46 centers participating in the FHDH to eithersimple information on guideline availability or active promotion with a multifaceted and repeated intervention comprising reminders and audit feedback and targeting of local opinion leaders carried out between April 2009 and April 2010. Outcome measure was CKD management adequacy assessed before and 2 years after the beginning of the intervention in HIV-infected patients with moderate to severe CKD. CKD management was considered adequate in case of referral to a nephrologist or if proteinuria, blood pressure, low-density lipoprotein cholesterol level, and glycemia had been measured during the previous year and medications had been prescribed when necessary. RESULTS:Three hundred six patients were enrolled, of whom 238 (78%) completed the 2 years of follow-up. During the study period, the percentage of patients receiving adequate CKD management improved from 64.1% to 70.4% (+6.3%) in the active arm and from 68.3% to 75.6% (+7.3%) in the control arm (adjusted mean difference, -0.7 percentage points [95% confidence interval: -9.2 to 7.9]; P = .95). The biggest impact of active promotion was on the management of proteinuria and blood pressure. CONCLUSIONS: Adequate compliance with CKD management guidelines improved slightly between 2009 and 2011, with no difference between the simple information and active promotion arms. CLINICAL TRIALS REGISTRATION: CCTIRS 10.150 and CNIL DR-2010-379.
RCT Entities:
BACKGROUND:Chronic kidney disease (CKD) is frequent in individuals infected with human immunodeficiency virus (HIV). Progression to end-stage renal disease can be slowed by appropriate medical management. METHODS: To assess whether active promotion of guidelines improves CKD management, we conducted a cluster randomized controlled trial within the French Hospital Database on HIV (FHDH-ANRS CO4). We randomized 46 centers participating in the FHDH to either simple information on guideline availability or active promotion with a multifaceted and repeated intervention comprising reminders and audit feedback and targeting of local opinion leaders carried out between April 2009 and April 2010. Outcome measure was CKD management adequacy assessed before and 2 years after the beginning of the intervention in HIV-infectedpatients with moderate to severe CKD. CKD management was considered adequate in case of referral to a nephrologist or if proteinuria, blood pressure, low-density lipoprotein cholesterol level, and glycemia had been measured during the previous year and medications had been prescribed when necessary. RESULTS: Three hundred six patients were enrolled, of whom 238 (78%) completed the 2 years of follow-up. During the study period, the percentage of patients receiving adequate CKD management improved from 64.1% to 70.4% (+6.3%) in the active arm and from 68.3% to 75.6% (+7.3%) in the control arm (adjusted mean difference, -0.7 percentage points [95% confidence interval: -9.2 to 7.9]; P = .95). The biggest impact of active promotion was on the management of proteinuria and blood pressure. CONCLUSIONS: Adequate compliance with CKD management guidelines improved slightly between 2009 and 2011, with no difference between the simple information and active promotion arms. CLINICAL TRIALS REGISTRATION: CCTIRS 10.150 and CNIL DR-2010-379.