Toshiyuki Imasawa1, Chie Saito2, Hirayasu Kai2, Kunitoshi Iseki3, Junichiro James Kazama4, Yugo Shibagaki5, Hitoshi Sugiyama6, Daisuke Nagata7, Ichiei Narita8, Tomoya Nishino9, Hajime Hasegawa10, Hirokazu Honda11, Shoichi Maruyama12, Mariko Miyazaki13, Masashi Mukoyama14, Hideo Yasuda15, Takashi Wada16, Yuichi Ishikawa17, Ryoya Tsunoda2, Kei Nagai2, Reiko Okubo18, Masahide Kondo18, Junichi Hoshino19, Kunihiro Yamagata2. 1. Department of Nephrology, National Hospital Organization Chiba-Higashi National Hospital, 673, Nitonacho, Chuo-ku Chiba City, Chiba, Japan. 2. Department of Nephrology, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, Japan. 3. Okinawa Heart and Renal Association (OHRA), 2-6-20, Aja, Naha, Okinawa, Japan. 4. Department of Nephrology and Hypertension, Fukushima Medical University, 1, Hikariga-oka, Fukushima, Japan. 5. Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, Japan. 6. Department of Human Resource Development of Dialysis Therapy for Kidney Disease, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, Japan. 7. Division of Nephrology, Department of Internal Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-shi, Tochigi, Japan. 8. Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata City, Niigata, Japan. 9. Department of Nephrology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, Japan. 10. Department of Nephrology and Hypertension, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoeshi, Saitama, Japan. 11. Division of Nephrology, Department of Medicine, Showa University School of Medicine, 1-5-8 Hatanodai Shinagawa-ku Tokyo, Japan. 12. Department of Nephrology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Japan. 13. Department of Nephrology, Endocrinology, and Vascular Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, Japan. 14. Department of Nephrology, Kumamoto University Graduate School of Medical Sciences, 1-1-1 Honjo, Chuo-ku, Kumamoto, Japan. 15. Internal Medicine 1, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu city, Shizuoka, Japan. 16. Department of Nephrology and Laboratory Medicine, Kanazawa University, 13-1, Takaramachi, Kanazawa, Ishikawa, Japan. 17. Department of Food Sciences, College of Life Sciences, Ibaraki Christian University, 6-11-1 Omika, Hitachi, Ibaraki, Japan. 18. Department of Health Care Policy and Health Economics, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, Japan. 19. Nephrology Center, Toranomon Hospital, 2-2-2, Toranomon, Minato-ku, Tokyo, Japan.
Abstract
BACKGROUND: Practice facilitation program by multidisciplinary care for primary care physicians is expected to improve chronic kidney disease (CKD) outcomes, but there is no clear evidence of its long-term effectiveness. We have previously performed a cluster-randomized controlled trial for 3.5 years (the FROM-J study) with two arms-group A without the program and group B with the program. We aimed to assess the long-term effectiveness of the practice facilitation program on CKD outcomes via an extended 10-year follow-up of the FROM-J study. METHODS: We enrolled patients who were in the FROM-J study. The primary composite endpoint comprised cardiovascular disease (CVD), renal replacement therapy initiation, and a 50% decrease in the eGFR. The secondary endpoints were survival rate, eGFR decline rate, and collaboration rate between primary care physicians and nephrologists. RESULTS: The occurrence of the primary composite endpoint tended to be lower in group B (group A: 27.1% vs. group B: 22.1%, p = 0.051). Furthermore, CVD incidence was remarkably lower in group B (group A: 10.5% vs. group B: 6.4%, p = 0.001). Although both mortality and the rate of eGFR decline were identical between both groups, the eGFR decline rate was significantly better in group B than in group A only in patients with stage G3a at enrollment (group A: 2.35±3.87 mL/min/1.73 m2/year vs. group B: 1.68±2.98 mL/min/1.73 m2/year, p = 0.02). The collaboration rate was higher in group B. CONCLUSIONS: The CKD practice facilitation program for primary care physicians reliably decreases CVD events and may reduce the progression of cases to end-stage kidney disease.
BACKGROUND: Practice facilitation program by multidisciplinary care for primary care physicians is expected to improve chronic kidney disease (CKD) outcomes, but there is no clear evidence of its long-term effectiveness. We have previously performed a cluster-randomized controlled trial for 3.5 years (the FROM-J study) with two arms-group A without the program and group B with the program. We aimed to assess the long-term effectiveness of the practice facilitation program on CKD outcomes via an extended 10-year follow-up of the FROM-J study. METHODS: We enrolled patients who were in the FROM-J study. The primary composite endpoint comprised cardiovascular disease (CVD), renal replacement therapy initiation, and a 50% decrease in the eGFR. The secondary endpoints were survival rate, eGFR decline rate, and collaboration rate between primary care physicians and nephrologists. RESULTS: The occurrence of the primary composite endpoint tended to be lower in group B (group A: 27.1% vs. group B: 22.1%, p = 0.051). Furthermore, CVD incidence was remarkably lower in group B (group A: 10.5% vs. group B: 6.4%, p = 0.001). Although both mortality and the rate of eGFR decline were identical between both groups, the eGFR decline rate was significantly better in group B than in group A only in patients with stage G3a at enrollment (group A: 2.35±3.87 mL/min/1.73 m2/year vs. group B: 1.68±2.98 mL/min/1.73 m2/year, p = 0.02). The collaboration rate was higher in group B. CONCLUSIONS: The CKD practice facilitation program for primary care physicians reliably decreases CVD events and may reduce the progression of cases to end-stage kidney disease.