Multidisciplinary care program for advanced chronic kidney disease: Reduces renal replacement and medical costs
Journal
American Journal of Medicine
Journal Volume
128
Journal Issue
1
Pages
68-76
Date Issued
2015
Abstract
BACKGROUND: Multidisciplinary care is advocated as an effective chronic kidney disease treatment program in a few, but not all, studies. Our study aimed to evaluate the effect of multidisciplinary care on renal outcome and patient survival using a larger cohort. METHOD: A total 1382 chronic kidney disease patients, ages 18-80 years, with chronic kidney disease stage 3B-5, in nephrology outpatient clinics were enrolled. Using age, sex, chronic kidney disease stage, and diabetes mellitus as variables, 592 multidisciplinary care program participants were matched with 614 nonmultidisciplinary care patients. The primary outcomes were long-term renal replacement therapy and mortality. Secondary outcomes included changes of biochemical markers and blood pressure, infection hospitalization, cardiovascular events, and emergent start of long-term dialysis. Annual medical costs were compared. RESULTS: There were no between-group differences regarding mortality. In the multivariate competing-risk regression model, the multidisciplinary care group had a better renal survival (hazard ratio 0.640; 95% confidence interval, 0.484-0.847; P = .002). This effect was most prominent in stage 4 (hazard ratio 0.375; 95% confidence interval, 0.219-0.640; P < .001), but not in stage 3B and 5 patients. The multidisciplinary care group showed a slower estimated glomerular filtration rate decline (±2.57 vs ±3.74 mL/min/1.73 m2, P = .021), and a smaller increase in phosphate ( 0.03 vs 0.33 mg/dL, P = .013). Cardiovascular and infection events were both decreased in the multidisciplinary care group (P < .001). There was also less requirement of emergent start dialysis (39.6% vs 54.5%, P = .001). The annual cost for the multidisciplinary care group was lower than the nonmultidisciplinary care group (US $2372 vs $3794, P < .001). In addition, considering the reduction of patients requiring renal replacement therapy, the multidisciplinary care program saved a total US $1931 per patient annually. CONCLUSIONS: Our analysis demonstrated that the multidisciplinary care program provided better health care and reduced renal replacement therapy in patients with advanced chronic kidney disease. By decreasing hospitalizations, emergent start, and the need for renal replacement therapy, the multidisciplinary care program was cost-effective. ? 2015 The Authors. Published by Elsevier Inc.
SDGs
Other Subjects
albumin; calcium; creatinine; hemoglobin; phosphate; uric acid; adult; aged; Article; cardiovascular disease; cardiovascular effect; chronic kidney disease; controlled study; diabetes mellitus; female; glomerulus filtration rate; health care cost; health program; hemoglobin blood level; hospitalization; human; infection; long term care; major clinical study; male; mortality; priority journal; protein urine level; renal replacement therapy; retrospective study; survival; treatment outcome; adolescent; economics; epidemiology; health care cost; interdisciplinary communication; middle aged; Renal Insufficiency, Chronic; renal replacement therapy; statistics and numerical data; Taiwan; very elderly; young adult; Adolescent; Adult; Aged; Aged, 80 and over; Female; Glomerular Filtration Rate; Health Care Costs; Humans; Interdisciplinary Communication; Male; Middle Aged; Renal Dialysis; Renal Insufficiency, Chronic; Retrospective Studies; Survival Analysis; Taiwan; Young Adult
Publisher
Elsevier Inc.
Type
journal article