The short- and long-term impact of multi-disciplinary clinics in addition to standard nephrology care on patient outcomes
The short- and long-term impact of multi-disciplinary clinics in addition to standard nephrology care on patient outcomes
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DOI：
10.1093/ndt/gfh585
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发表时间：
2005-01-01
影响因子：
6.1
通讯作者：
Levin, A
中科院分区：
文献类型：
--
作者：
Curtis, BM;Ravani, P;Levin, A
背景这两个国家的事件透析患者的病例对照研究评估的结果，患者暴露于正式的多学科诊所（MDC）程序与标准的肾病科医生的治疗。在透析开始时和透析开始后，对两个中心（加拿大温哥华和意大利克雷莫纳）开始透析的患者进行了评价，作为MDC暴露与单独肾病学家治疗的函数。仅纳入接受肾脏护理超过3个月且既往未接受肾脏替代治疗的慢性肾脏疾病患者。研究结果包括实验室参数和生存率。两个国家的MDC相似，平均暴露时间为6-8小时/患者年，而标准治疗为2-4小时。所有患者在透析前和透析开始时都能平等地获得资源，因为所有患者都被转诊到相同的当地肾脏病诊所。在评价期间，288例患者在透析前接受超过3个月的肾脏护理后开始透析。队列之间没有重大的人口统计学差异。透析前平均肾脏病护理时间为42个月，透析开始时肾小球滤过率（GFR）相似，但差异具有统计学意义（7.0和8.4 ml/min/m2，P=0.001）。MDC患者的血红蛋白（102 vs 90 g/l，P < 0.0001）、白蛋白（37.0 vs 34.8 g/l，P=0.002）和钙水平（2.29 vs 2.16 mmol/l，P
Background. This two country case control study of incident dialysis patients evaluates the outcomes of patients exposed to formalized multi-disciplinary clinic (MDC) programmes vs standard nephrologist care.Methods. Patients commencing dialysis in two centres (Vancouver, Canada and Cremona, Italy) were evaluated at and after dialysis start, as a function of MDC exposure vs nephrologist care alone. Only chronic kidney disease patients, with longer than 3 months of exposure to nephrology care, who had not previously received kidney replacement therapy were included. Study outcomes included laboratory parameters and survival. The MDC was similar in both countries and average exposure was 6-8 h per patient-year, as compared to 2-4 h for standard care. All patients had equal access to resources prior to dialysis and with respect to dialysis start, as all had been referred to the same local nephrology practices.Results. During the evaluation period 288 patients commenced dialysis after receiving more than 3 months nephrology care prior to dialysis. There were no major demographic differences between the cohorts. Mean duration of nephrology care prior to dialysis was 42 months, and dialysis was initiated at similar low glomerular filtration rate (GFR), though statistically significantly different (7.0 and 8.4 ml/min/m(2), P=0.001). The MDC patients had higher haemoglobin (102 vs 90 g/l, P < 0.0001), albumin (37.0 vs 34.8 g/l, P=0.002) and calcium levels (2.29 vs 2.16 mmol/l, P