Yoshihiko Imamura1, Yasunori Takahashi2, Satoru Uchida3, Masateru Iwamoto3, Rie Nakamura4, Miki Yamauchi4, Yuka Ogawara5, Mikiko Goto5, Kazuyo Takeba5, Naomi Yaguchi6, Nobuhiko Joki7. 1. Department of Nephrology, Nissan Tamagawa Hospital, 4-8-1 Seta Setagaya-ku, Tokyo, 158-0095, Japan. yoshihiko.imamura@gmail.com. 2. Department of Nephrology, Nissan Tamagawa Hospital, 4-8-1 Seta Setagaya-ku, Tokyo, 158-0095, Japan. 3. Department of Diabetes, Nissan Tamagawa Hospital, 4-8-1 Seta Setagaya-ku, Tokyo, 158-0095, Japan. 4. Division of Nursing, Nissan Tamagawa Hospital, 4-8-1 Seta Setagaya-ku, Tokyo, 158-0095, Japan. 5. Division of Pharmacy, Nissan Tamagawa Hospital, 4-8-1 Seta Setagaya-ku, Tokyo, 158-0095, Japan. 6. Division of Nutrition Management, Nissan Tamagawa Hospital, 4-8-1 Seta Setagaya-ku, Tokyo, 158-0095, Japan. 7. Division of Nephrology, Toho University Medical Center Ohashi Hospital, 2-22-36 Ohashi, Meguro-ku, Tokyo, 153-8515, Japan.
Abstract
BACKGROUND: The aim of comprehensive multidisciplinary care (MDC) by the chronic kidney disease (CKD) team is not only to prevent worsening renal function, but also provide education on the selection of renal replacement therapy (RRT) by shared decision making (SDM). The purpose of this study was to examine the effects of MDC for predialysis outpatients on dialysis therapy, especially with regard to peritoneal dialysis (PD). METHODS: This study evaluated 112 CKD patients who underwent dialysis at our hospital starting from 2012, with 53 outpatients receiving MDC from the CKD team and 59 outpatients not receiving MDC. Annual decreases in the estimated glomerular filtration rates (ΔeGFR), the duration from the time of intervention to dialysis initiation, the urgent dialysis rate using a temporary catheter, and the PD selection rate were compared and examined between the two groups. The ΔeGFR, the duration from intervention to PD initiation, and the PD retention rate were compared between 18 PD patients in the MDC group and 10 PD patients in the non-MDC group. RESULTS: The MDC group had a significantly lower ΔeGFR, significantly longer duration, and a significantly lower urgent dialysis initiation rate versus the non-MDC group. Moreover, there was a significantly higher PD selection rate, significantly prolonged duration, and significantly higher PD retention rate. CONCLUSIONS: Multidisciplinary CKD team care for outpatients is effective in delaying the progression of CKD and avoiding the initiation of urgent dialysis; contributing to improved PD selectivity and continuity by SDM.
BACKGROUND: The aim of comprehensive multidisciplinary care (MDC) by the chronic kidney disease (CKD) team is not only to prevent worsening renal function, but also provide education on the selection of renal replacement therapy (RRT) by shared decision making (SDM). The purpose of this study was to examine the effects of MDC for predialysis outpatients on dialysis therapy, especially with regard to peritoneal dialysis (PD). METHODS: This study evaluated 112 CKD patients who underwent dialysis at our hospital starting from 2012, with 53 outpatients receiving MDC from the CKD team and 59 outpatients not receiving MDC. Annual decreases in the estimated glomerular filtration rates (ΔeGFR), the duration from the time of intervention to dialysis initiation, the urgent dialysis rate using a temporary catheter, and the PD selection rate were compared and examined between the two groups. The ΔeGFR, the duration from intervention to PD initiation, and the PD retention rate were compared between 18 PDpatients in the MDC group and 10 PDpatients in the non-MDC group. RESULTS: The MDC group had a significantly lower ΔeGFR, significantly longer duration, and a significantly lower urgent dialysis initiation rate versus the non-MDC group. Moreover, there was a significantly higher PD selection rate, significantly prolonged duration, and significantly higher PD retention rate. CONCLUSIONS: Multidisciplinary CKD team care for outpatients is effective in delaying the progression of CKD and avoiding the initiation of urgent dialysis; contributing to improved PD selectivity and continuity by SDM.
Entities:
Keywords:
Chronic kidney disease (CKD); Health educator; Multidisciplinary care (MDC); Peritoneal dialysis (PD); Renal replacement therapy (RRT); Shared decision making (SDM)
Authors: Elizabeth A Bayliss; Bharati Bhardwaja; Colleen Ross; Arne Beck; Diane M Lanese Journal: Clin J Am Soc Nephrol Date: 2011-01-27 Impact factor: 8.237
Authors: Ai-Hua Zhang; Paul Tam; Denise LeBlanc; Hui Zhong; Christopher T Chan; Joanne M Bargman; Dimitrios G Oreopoulos Journal: Int Urol Nephrol Date: 2009-07-04 Impact factor: 2.370
Authors: Andrea M Easom; Ashutosh M Shukla; Dumitru Rotaru; Songthip Ounpraseuth; Sudhir V Shah; John M Arthur; Manisha Singh Journal: Clin Kidney J Date: 2019-08-22
Authors: Noel Engels; Gretchen N de Graav; Paul van der Nat; Marinus van den Dorpel; Anne M Stiggelbout; Willem Jan Bos Journal: BMJ Open Date: 2022-09-21 Impact factor: 3.006