Background:Multidisciplinary chronic kidney disease (CKD) clinics improve patient
outcomes but their optimal design is unclear.Objective:To perform a scoping review to identify and describe current practices
(structure, function) associated with multidisciplinary CKD clinics.Design:Scoping review.Setting:Databases included Medline, EMBASE, Cochrane, and CINAHL.Patients:Patients followed in multidisciplinary CKD clinics globally.Measurements:Multidisciplinary CKD clinic composition, entry criteria, follow-up, and
outcomes.Methods:We systematically searched the literature to identify randomized controlled
trials, non-randomized interventional studies, or observational studies of
multidisciplinary CKD clinics defined by an outpatient setting where two or
more allied health members (with or without a nephrologist) provided
longitudinal care to 50 or more adult or pediatric patients with CKD.
Included studies were from 2002 to present. Searches were completed on
August 10, 2018. Title, abstracts, and full texts were screened
independently by two reviewers with disagreements resolved by a third. We
abstracted data from included studies to summarize multidisciplinary CKD
clinic team composition, entry criteria, follow-up, and processes.Results:40 studies (8 randomized controlled trials and 32 non-randomized
interventional studies or observational studies) involving 23 230
individuals receiving multidisciplinary CKD care in 12 countries were
included. Thirty-eight focused on adults (27 with CKD, 10 incident dialysis
patients, one conservative therapy) while two studies focused on adolescents
or children with CKD. The multidisciplinary team included a mean of 4.6 (SD
1.5) members consisting of a nephrologist, nurse, dietician, social worker,
and pharmacist in 97.4%, 86.8%, 84.2%, 57.9%, and 42.1% of studies
respectively. Entry criteria to multidisciplinary CKD clinics ranged from
glomerular filtration rates of 20 to 70 mL/min/1.73m2 or CKD
stages 1 to 5 without any proteinuria or risk equation-based criteria.
Frequency of follow-up was variable by severity of kidney disease. Team
member roles and standardized operating procedures were infrequently
reported.Limitations:Unstandardized definition of multidisciplinary CKD care, studies limited to
CKD defined by glomerular filtration rate, and lack of representation from
countries other than Canada, Taiwan, the United States, and the United
Kingdom.Conclusions:There is heterogeneity in multidisciplinary CKD team composition, entry
criteria, follow-up, and processes with inadequate reporting of this complex
intervention. Additional research is needed to determine the best model for
multidisciplinary CKD clinics.Trial registration:Not applicable.