Adherence to multidisciplinary care in a prospective chronic kidney disease cohort is associated with better outcomes

Ríos, Pablo; Solá, Laura; Ferreiro, Alejandro; Silvariño, Ricardo; Lamadrid, Verónica; Ceretta, Laura; Gadola, Liliana

doi:10.1371/journal.pone.0266617

Cited by 22 publications

(16 citation statements)

References 72 publications

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“…Covariates used for PS calculation were sex, age, number of hospital beds, index eGFR, duration of diabetes, medications, and procedures. Other covariates were not used because of missing values, and we believe that the covariates used were sufficient to adjust for confounding factors based on previous studies [ 18 , 32 – 34 ]. We used 1:5 matching, a logistic regression model, and the non-replacement nearest-neighbor method with a caliper width of 0.2 of the SD.…”

Section: Methodsmentioning

confidence: 99%

Effect of multidisciplinary care on diabetic kidney disease: a retrospective cohort study

Hayashi,

Mizuno,

Shinkawa

et al. 2024

BMC Nephrol

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Background Diabetic kidney disease (DKD) is the most common disease among patients requiring dialysis for the first time in Japan. Multidisciplinary care (MDC) may prevent the progression of kidney failure. However, the effectiveness and timing of MDC to preserve kidney function in patients with DKD is unclear. Therefore, the aim of this study was to investigate whether MDC for patients with DKD affects the preservation of kidney function as well as the timing of MDC in clinical practice. Methods In this retrospective cohort study, we identified patients with type 2 diabetes mellitus and DKD from April 2012 to January 2020 using a nationwide Japanese healthcare record database. The fee code for medical guidance to prevent dialysis in patients with diabetes was used to distinguish between the MDC and non-MDC groups. The primary outcome was a 40% decline in the estimated glomerular filtration rate, and secondary outcomes were death, hospitalization, permanent dialysis, kidney failure with replacement therapy, and emergency temporary catheterization. Propensity score matching was performed, and Kaplan–Meier and multivariable Cox regression analyses were performed. Results Overall, 9,804 eligible patients met the inclusion criteria, of whom 5,614 were matched for the main analysis: 1,039 in the MDC group, and 4,575 in the non-MDC group. The primary outcome did not differ between the groups (hazard ratio: 1.18, [95% confidence interval: 0.99–1.41], P = 0.07). The groups also did not differ in terms of the secondary outcomes. Most patients with DKD received their first MDC guidance within 1 month of diagnosis, but most received guidance only once per year. Conclusions Although we could not demonstrate the effectiveness of MDC on kidney function in patients with DKD, we clarified the characteristics of such patients assigned the fee code for medical guidance to prevent dialysis related to diabetes.

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Section: Methodsmentioning

confidence: 99%

Effect of multidisciplinary care on diabetic kidney disease: a retrospective cohort study

Hayashi,

Mizuno,

Shinkawa

et al. 2024

BMC Nephrol

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“…Patients are often managed by multiple specialists, leading to fragmentation of care, lack of holistic oversight and diffusion of responsibility for treatment. Multidisciplinary care improved transition to kidney replacement therapy and lowered mortality in single and combined outcomes analyses (Rios et al, 2022). Novel models of ‘combined clinics’ with on‐site collaboration and coparticipation (nephrologist–cardiologist–endocrinologist) may prove to be of substantial benefit for patients, in terms of reduced fragmentation of care, logistics and cost saving.…”

Section: Closing the ‘Gap’ Between What We Know And What We Domentioning

confidence: 99%

Mind the gap in kidney care: Translating what we know into what we do

Luyckx,

Tuttle,

Abdellatif

et al. 2024

Journal of Renal Care

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Historically, it takes an average of 17 years to move new treatments from clinical evidence to daily practice. Given the highly effective treatments now available to prevent or delay kidney disease onset and progression, this is far too long. The time is now to narrow the gap between what we know and what we do. Clear guidelines exist for the prevention and management of common risk factors for kidney disease, such as hypertension and diabetes, but only a fraction of people with these conditions worldwide are diagnosed, and even fewer are treated to target. Similarly, the vast majority of people living with kidney disease are unaware of their condition, because in the early stages it is often silent. Even among patients who have been diagnosed, many do not receive appropriate treatment for kidney disease. Considering the serious consequences of kidney disease progression, kidney failure, or death, it is imperative that treatments are initiated early and appropriately. Opportunities to diagnose and treat kidney disease early must be maximized beginning at the primary care level. Many systematic barriers exist, ranging from patient to clinician to health systems to societal factors. To preserve and improve kidney health for everyone everywhere, each of these barriers must be acknowledged so that sustainable solutions are developed and implemented without further delay.

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“…Policies enable rational utilization of resources, guide funding for infrastructure development, and allocation of services for optimal utilization and maximal benefit of end-users. Indeed, success of a national CKD policy has been observed in Uruguay where, since incorporation of screening for CKD in high-risk populations (case finding) into mandatory health checkups of the working population in 2009 quality of care has improved, with patients being better prepared for KRT (e.g., 44.2% vs. 21.2% having an arteriovenous fistula at the start of dialysis) and mortality among people with CKD has decreased (6.74-4.92 deaths/100 patient years) [65,66]. The ISN-Global Kidney Health Atlas (GKHA) survey found that under half of the 160 participant countries (47%) had a national NCD strategy [67].…”

Section: Health Policymentioning

confidence: 99%

Equity and Quality of Global Chronic Kidney Disease Care: What Are We Waiting for?

Luyckx,

Elmaghrabi,

Sahay

et al. 2023

Am J Nephrol

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Background: Chronic kidney disease (CKD) is an important but insufficiently recognized public health problem. Unprecedented advances in delaying progression of CKD and reducing kidney failure and death have been made in recent years, with the addition of the sodium glucose co-transporter 2 inhibitors and other newer medication to the established standard of care with inhibitors of the renin angiotensin system. Despite knowledge of these effective therapies, their prescription and use remains suboptimal globally, and more specially in low resource settings. Many challenges contribute to this gap between knowledge and translation into clinical care, which is even wider in lower resource settings across the globe. Implementation of guideline-directed care is hampered by lack of disease awareness, late or missed diagnosis, clinical inertia, poor quality care, cost of therapy, systemic biases, and lack of patient empowerment. All of these are exacerbated by the social determinants of health and global inequities. Summary CKD is a highly manageable condition but requires equitable and sustainable access to quality care supported by health policies, health financing, patient and healthcare worker education and affordability of medications and diagnostics. Key Messages The gap between the knowledge and tools to treat CKD and the implementation of optimal quality kidney care should no longer be tolerated. Advocacy, research and action are required to improve equitable access to sustainable quality care for CKD everywhere.

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Adherence to multidisciplinary care in a prospective chronic kidney disease cohort is associated with better outcomes

Cited by 22 publications

References 72 publications

Effect of multidisciplinary care on diabetic kidney disease: a retrospective cohort study

Effect of multidisciplinary care on diabetic kidney disease: a retrospective cohort study

Mind the gap in kidney care: Translating what we know into what we do

Equity and Quality of Global Chronic Kidney Disease Care: What Are We Waiting for?

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