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

Factors associated with poor sleep quality in patients with pre‐dialysis chronic kidney disease: A systematic review

“…This systematic review not only provides a holistic summary of all the potential risk factors for poor sleep quality in all stages of CKD but also demonstrates the existence of intersectionality among symptoms, renal function and sleep quality in patients with CKD. Multi-disciplinary team coordination has been recognized as an essential approach (Lin et al, 2022) to prevent and manage the risk factors that were summarized in this paper. For example, Taiwan government used the universal health insurance system data to make an informed decision on integrating • Most read nursing journal in the world: over 3 million articles downloaded online per year and accessible in over 10,000 libraries worldwide (including over 6,000 in developing countries with free or low cost access).…”

CKD Care Programs and Incident Kidney Failure: A Study of a National Disease Management Program in Taiwan

“… 12 , 13 , 14 , 15 Similar to these individual-level observations, our findings reflect that the universal CKD care programs could decline the long-term trend of dialysis incidence. Although the fundamental mechanisms of the results are yet to be clarified, recent evidence suggests that more appropriate medication prescriptions, 5 , 16 education and dietary interventions, 17 , 18 complication management, 19 dialysis preparation, 20 as well as their interactions may play essential roles in prolonging kidney disease progression and dialysis initiation. In addition, our results, together with previous reports, 5 , 12 , 21 suggested that the care programs could significantly reduce cardiovascular disease or infectious disease-related mortality, particularly in the first year of dialysis, through improving the electrolyte imbalance correction and arteriovenous fistula preparation.…”

“…Although the fundamental mechanisms of the results are yet to be clarified, recent evidence suggests that more appropriate medication prescriptions, 5 , 16 education and dietary interventions, 17 , 18 complication management, 19 dialysis preparation, 20 as well as their interactions may play essential roles in prolonging kidney disease progression and dialysis initiation. In addition, our results, together with previous reports, 5 , 12 , 21 suggested that the care programs could significantly reduce cardiovascular disease or infectious disease-related mortality, particularly in the first year of dialysis, through improving the electrolyte imbalance correction and arteriovenous fistula preparation. 12 It is true that the Taiwan government must pay additional fees for patient education, dietician consultations, and laboratory examinations when it performs the 2 CKD care programs; however, overall, the cost is lower than that of conventional care when the programs prevent patients from starting dialysis or repeated hospitalizations.…”

“… 4 According to the Taiwan Renal Data System, the program has covered over half (55%-63%) of the patients who started long-term dialysis treatment from 2013-2018. 5 To extend the preventive concept to an earlier stage and to specialists other than nephrologists, another care incentive program named Early-CKD Care was launched in 2011 for patients whose estimated glomerular filtration rate was between 45 and 59 mL/min/1.73 m 2 and for those whose estimated glomerular filtration rate was ≥60 mL/min/1.73 m 2 with accompanying proteinuria. The Early-CKD Care program paid an additional bonus for timely patient enrollment, regular evaluation, and nephrology referral.…”

Framework of Guidelines for Management of CKD in Asia

“…Based on retrospective studies and systematic analysis of referrals in various countries, current evidence strongly supports the early referral (>12 months prior to initiation of KRT) of patients with CKD to nephrologists and multidisciplinary care programs. 176 , 181 Referral to nephrology is also important for planning KRT and transplant evaluation. The trajectories of GFR decline are highly variable and depend on albuminuria, age, types of kidney disease, comorbidity, and effective risk factor control.…”