Yoshihiko Imamura1, Yasunori Takahashi2, Takato Takeuchi3, Masateru Iwamoto3, Miki Yamauchi4, Rie Nakamura4, Yuka Ogawara5, Kazuyo Takeba5, Makoto Shinohara6, 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 Ohashi Medical Center, 2-22-36 Ohashi, Meguro-Ku, Tokyo, 153-8515, Japan.
Abstract
BACKGROUND: Although multidisciplinary care (MDC) is necessary for controlling chronic kidney disease (CKD), its impact on compliance with management target values in the CKD guidelines remains unclear. This study was designed to clarify the relationship between compliance with management target values and renal prognosis in CKD outpatients who received MDC. METHODS: There were 255 outpatients with pre-dialysis CKD who received MDC. Achievement rates of systolic, and diastolic blood pressure, hemoglobin, uric acid, low-density lipoprotein cholesterol, and hemoglobin A1c values determined according to CKD guidelines were compared before and 12 months after MDC. In addition, after dividing achievement rates of the target values at 12 months after MDC into four groups (A < 30% ≤ B < 60% ≤ C < 80% ≤ D), dialysis initiation and renal survival rates were compared. RESULTS: There was a significant increase in the overall achievement rate from 62.8 to 69.1% (p < 0.001). The higher the achievement rate after MDC, the lower the dialysis initiation rate (A 72.7%, B 35.3%, C 20.5%, D 8.2%, p < 0.001). There was also a significantly higher renal survival rate (p < 0.001). These findings suggest that MDC for CKD raised awareness of health literacy, and improved the achievement rate of target values. Furthermore, the higher the achievement rate, the later the initiation of dialysis, which led to improvement of renal survival. CONCLUSIONS: MDC can improve compliance with management target values for CKD, suggesting that it may improve renal prognosis.
BACKGROUND: Although multidisciplinary care (MDC) is necessary for controlling chronic kidney disease (CKD), its impact on compliance with management target values in the CKD guidelines remains unclear. This study was designed to clarify the relationship between compliance with management target values and renal prognosis in CKD outpatients who received MDC. METHODS: There were 255 outpatients with pre-dialysis CKD who received MDC. Achievement rates of systolic, and diastolic blood pressure, hemoglobin, uric acid, low-density lipoprotein cholesterol, and hemoglobin A1c values determined according to CKD guidelines were compared before and 12 months after MDC. In addition, after dividing achievement rates of the target values at 12 months after MDC into four groups (A < 30% ≤ B < 60% ≤ C < 80% ≤ D), dialysis initiation and renal survival rates were compared. RESULTS: There was a significant increase in the overall achievement rate from 62.8 to 69.1% (p < 0.001). The higher the achievement rate after MDC, the lower the dialysis initiation rate (A 72.7%, B 35.3%, C 20.5%, D 8.2%, p < 0.001). There was also a significantly higher renal survival rate (p < 0.001). These findings suggest that MDC for CKD raised awareness of health literacy, and improved the achievement rate of target values. Furthermore, the higher the achievement rate, the later the initiation of dialysis, which led to improvement of renal survival. CONCLUSIONS: MDC can improve compliance with management target values for CKD, suggesting that it may improve renal prognosis.
Authors: Peter Gaede; Pernille Vedel; Nicolai Larsen; Gunnar V H Jensen; Hans-Henrik Parving; Oluf Pedersen Journal: N Engl J Med Date: 2003-01-30 Impact factor: 91.245