Effect of nephrology referrals and multidisciplinary care programs on renal replacement and medical costs on patients with advanced chronic kidney disease

Chen, Jui-Hsin; Chiu, Yi‐Wen; Hwang, Shang‐Jyh; Tsai, Jer‐Chia; Shi, Hon-Yi; Lin, Ming‐Yen

doi:10.1097/md.0000000000016808

Cited by 10 publications

(11 citation statements)

References 32 publications

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“…Regarding secondary outcome indicators, two studies reported that MDC significantly decreased the emergency hemodialysis rate and annual medical costs. One study reported that MDC significantly decreased end‐stage renal disease (ESRD) risk (Chen et al, 2019). Inconsistent results have been reported for other outcome indicators, including hospitalization for cardiovascular or infection events, medications use, and incidence of dialysis.…”

Section: Resultsmentioning

confidence: 99%

“…Some studies also recommend inclusion of other specialists (e.g., cardiac surgeon, urological surgeon, pharmacist, psychotherapist, and social worker). In Taiwan, MDC for stage 3–5 CKD patients includes a nephrologist, renal health education professional, and nutritionist (Chen et al, 2019; P. M. Chen et al, 2015; Chen et al, 2013). The MDC in other countries includes surgeons (cardiovascular surgeon, general surgeon) and a kidney transplant team to provide the optimal care needed to prevent or delay worsening of renal function and to improve care and quality of life for CKD patients (Fluck & Taal, 2018; Johns et al, 2015; Wang et al, 2015).…”

Section: Discussionmentioning

confidence: 99%

“…Our study showed that, on average, patients return for a follow‐up visit every 1–6 months after an MDC intervention. Two previous Taiwan studies have compiled substantial data for MDC outcomes, and their study protocols reflected current CKD care plans in Taiwan (Chen et al, 2019; Chen et al, 2015; Chen et al, 2013). According to the Taiwan National Health Insurance Bureau (National Health Insurance Administration, 2015), follow‐up of CKD patients should vary by CKD stage.…”

Section: Discussionmentioning

confidence: 99%

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Effectiveness of Multidisciplinary Care for Chronic Kidney Disease: A Systematic Review

Hsu

Chiang

Lai

et al. 2020

Worldviews Ev Based Nurs

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Background Chronic kidney disease (CKD) is a common chronic disease. As this disease is extremely complex, multidisciplinary care (MDC) is needed to provide complete and continuous care. Aim A systematic literature review was performed to examine the constituents of MDC, the content of MDC interventions, and the health outcomes in CKD patients receiving MDC. Methods Searches of five Chinese and English databases for studies of CKD patients who had received MDC from 2007 to 2019 revealed 11 studies, which comprised 16,066 CKD patients. The Physiotherapy Evidence Database scale (Physiotherapy Evidence Database, 2017) was used to appraise study quality for randomized controlled trials, and the Joanna Briggs Institute Critical Appraisal tools (Joanna Briggs Institute, 2017) were for cohort studies. Results The MDC teams that provided comprehensive medical care for these patients included nephrologists, nurses, surgeons, general practitioners, pharmacists, psychotherapists, social workers, nutritionists, and other specialists. The literature review revealed that MDC for CKD slows the decline in estimated glomerular filtration rate and decreases patient mortality, the risk of renal replacement therapy, the need for emergent dialysis, and annual medical costs. Analyses of biochemical markers in the CKD patients showed that MDC improves control of serum levels of calcium and phosphate, improves control of parathyroid hormone, and reduces proteinuria and fasting blood glucose values. However, further studies are needed to determine the effects of MDC on all‐cause mortality, blood pressure control, hospitalization rate, hospitalization for cardiovascular or infection events, medications use, and other biochemical markers in CKD patients. Linking Evidence to Action Cross‐disciplinary collaboration of healthcare professionals is needed to ensure that patients undergo regular follow‐up and periodic assessment of clinical status, in addition to ensuring that relevant resources and assistance are provided in a timely manner. A follow‐up period of at least 2 years is also needed to ensure sufficient time to observe MDC results.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Effectiveness of Multidisciplinary Care for Chronic Kidney Disease: A Systematic Review

Hsu

Chiang

Lai

et al. 2020

Worldviews Ev Based Nurs

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“…Management and education were dependent on the stages of CKD, according to the 2002 NKF-KDOQI guidelines 17 , and the reimbursement policies of National Health Insurance (NHI). Detailed contents of this program have been described somewhere in our previous studies 12 , 18 . In 2006, Taiwan NHI launched a pay-for-performance program with indicators including CKD management, patient education, continuous care, remission of proteinuria, and maintenance of renal function for pre-End Stage Kidney Disease (ESKD) care 19 , 20 .…”

Section: Methodsmentioning

confidence: 99%

“…It further recommends referral for VA assessment and subsequent creation when the eGFR is 15–20 mL/min/1.73 m 2 , given that it is unlikely to predict the time of dialysis initiation 11 . In past decades, multidisciplinary chronic kidney disease (CKD) care programs have emerged and resulted in more effective prescriptions, a lower renal progression rate, a decrease in temporary dialysis catheter usage, and lower medical expenses 12 – 16 . Under the care of such a program, later referral and regular monitoring of renal progression were more under control; this made it easier to evaluate the time of determining when to create VA and how it affected the initiation of HD without using a central venous catheter.…”

Section: Introductionmentioning

confidence: 99%

Association of glomerular filtration rate slope with timely creation of vascular access in incident hemodialysis

Lim

Lin

Hwang

et al. 2021

Sci Rep

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The factors associated with the timely creation of distal vascular access for hemodialysis initiation are unclear. We aimed to explore the association between the slope of estimated glomerular filtration rate (eGFR) and the successful usage of vascular access upon hemodialysis initiation. This single center retrospective cohort study enrolled chronic kidney disease patients who undertook a multidisciplinary care program from 2003 to 2016. Using eGFR slope as predictor, we evaluated the vascular access created timely upon hemodialysis initiation. Among the 987 patients, vascular access was created at a median eGFR of 5.8 min/ml/1.73 m2, with a median duration of 3.1 months before hemodialysis. The proportions of vascular access created timely, created not timely (vascular access immature), and not created were 68.5%, 8.8%, and 22.7%, respectively. There was a significant negative association of eGFR upon vascular access creation with eGFR slope (r = − 0.182, P < 0.001). The fastest eGFR slope patients (the first quartile or < − 10 min/ml/1.73 m2/year) had the lowest percentage of vascular access created timely. In the multivariable logistic regression analysis, only higher eGFR upon vascular access creation (P = 0.001) and eGFR slope (P = 0.009) were significantly associated with vascular access created timely. The adjusted odds ratios of each quartile of eGFR slopes for vascular access created timely were 0.46 (95% confidence interval 0.27–0.86), 1.30 (0.62, 2.72), 1.00 (reference), and 0.95 (0.48–1.87), respectively. eGFR slope is associated with the timely creation of vascular access for the initiation of hemodialysis in a reverse-J-shaped pattern and may help determine the time of vascular access creation.

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Multidisciplinary care program in pre-end-stage kidney disease from 2010 to 2018 in Taiwan

Lin

Chang

et al. 2022

Journal of the Formosan Medical Association

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Effect of nephrology referrals and multidisciplinary care programs on renal replacement and medical costs on patients with advanced chronic kidney disease

Abstract: Supplemental Digital Content is available in the text

Cited by 10 publications

References 32 publications

Effectiveness of Multidisciplinary Care for Chronic Kidney Disease: A Systematic Review

Effectiveness of Multidisciplinary Care for Chronic Kidney Disease: A Systematic Review

Association of glomerular filtration rate slope with timely creation of vascular access in incident hemodialysis

Multidisciplinary care program in pre-end-stage kidney disease from 2010 to 2018 in Taiwan

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