Impact of prior CKD management in a renal care network on early outcomes in incident dialysis patients: a prospective observational study

Background Effective therapeutic strategies are available to prevent adverse outcomes in patients with chronic kidney disease (CKD) but their clinical results are hindered by unplanned implementation. Coordination of care emerges as a suitable way to improve patient outcomes. In this study, we evalu...

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Veröffentlicht in:BMC nephrology Jg. 14; H. 1; S. 41
Hauptverfasser: Rognant, Nicolas, Alamartine, Eric, Aldigier, Jean Claude, Combe, Christian, Vendrely, Benoit, Deteix, Patrice, Cluzel, Pascal, Juillard, Laurent, Vrtovsnik, François, Maurice, Christelle, Fave, Sophie, Laville, Maurice
Format: Journal Article
Sprache:Englisch
Veröffentlicht: London BioMed Central 20.02.2013
BioMed Central Ltd
Springer Nature B.V
Schlagworte:
Aged
Blood pressure
Cardiovascular Diseases - epidemiology
Cardiovascular Diseases - mortality
Chronic kidney failure
Community Networks - utilization
Comorbidity
Family physicians
Female
Hemodialysis
Humans
Incidence
Internal Medicine
Kidney diseases
Male
Medical research
Medicine
Medicine & Public Health
Medicine, Experimental
Mortality
Nephrology
Nephrology - statistics & numerical data
Patient Care Management
Patient Care Planning
Patient outcomes
Prospective Studies
Renal Dialysis - mortality
Renal Insufficiency, Chronic - epidemiology
Renal Insufficiency, Chronic - mortality
Research Article
Risk Factors
Studies
Survival Analysis
Survival Rate
Teaching hospitals
Treatment Outcome
France
Multidisciplinary intervention
Cardiovascular events
Renal cares network
Chronic kidney disease
CKD progression
ISSN:1471-2369, 1471-2369
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Zusammenfassung:Background Effective therapeutic strategies are available to prevent adverse outcomes in patients with chronic kidney disease (CKD) but their clinical results are hindered by unplanned implementation. Coordination of care emerges as a suitable way to improve patient outcomes. In this study, we evaluated the effect of planned and coordinated patient management within a dedicated renal care network comparatively to standard renal care delivered in nephrology departments of teaching hospitals. Methods This observational matched cohort study included 40 patients with CKD stage 4–5 in the network group as compared with a control group of 120 patients matched for age, sex and diabetic status. Main outcome was a composite endpoint of death from cardiovascular cause and cardiovascular events during the first year after dialysis initiation. Results There was no difference between the two groups neither for the primary outcome (40% vs 41%) nor for the occurrence of death from cardiovascular cause or cardiovascular events. Whereas the proportion of patients requiring at least one hospitalization was identical (83.3% vs 75%), network patients experienced less individual hospitalizations than control patients (2.3±2.0 vs 1.6±1.7) during the year before dialysis start. Patients of the network group had a slower renal function decline (7.7±2.5 vs 4.9±1.1 ml/min/1,73m 2 per year; p=0.04). Conclusions In this limited series of patients, we were unable to demonstrate a significant impact of the coordinated renal care provided in the network on early cardiovascular events in incident dialysis patients. However, during the predialysis period, there were less hospitalizations and a slower slope of renal function decrease.
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ISSN:1471-2369
1471-2369
DOI:10.1186/1471-2369-14-41