Multidisciplinary Care Program for Advanced Chronic Kidney Disease: Reduces Renal Replacement and Medical Costs
Multidisciplinary Care Program for Advanced Chronic Kidney Disease: Reduces Renal Replacement and Medical Costs
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DOI：
10.1016/j.amjmed.2014.07.042
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发表时间：
2015-01-01
影响因子：
5.9
通讯作者：
Tsai, Tun Jun
中科院分区：
文献类型：
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作者：
Chen, Ping Min;Lai, Tai Shuan;Tsai, Tun Jun
背景：在少数但不是所有的研究中，多学科护理被认为是一种有效的慢性肾脏病治疗方案。我们的研究旨在评估多学科护理对肾脏预后和患者生存率的影响，使用一个更大的coherent.METHOD：共1382例慢性肾脏病患者，年龄18-80岁，慢性肾脏病3B-5期，在肾脏科门诊入选。以年龄、性别、慢性肾脏病分期和糖尿病为变量，将592名多学科护理计划参与者与614名非多学科护理患者相匹配。主要结局是长期肾脏替代治疗和死亡率。次要结局包括生化标志物和血压的变化、感染住院、心血管事件和紧急开始长期透析。年医疗费用进行了比较。结果：有没有组间差异死亡率。在多变量竞争风险回归模型中，多学科护理组的肾脏存活率更高（风险比0.640; 95%置信区间，0.484-0.847; P = 0.002）。这种影响在4期患者中最为突出（风险比0.375; 95%置信区间，0.219-0.640; P <0.001），但在3B期和5例患者中则不明显。多学科治疗组显示肾小球滤过率下降较慢（-2.57 vs -3.74 mL/min/1.73 m2，P = 0.021），磷酸盐增加较小（+ 0.03 vs + 0.33 mg/dL，P = 0.013）。多学科护理组的心血管和感染事件均减少（P <0.001）。紧急开始透析的需求也较少（39.6% vs 54.5%，P = .001）。多学科护理组的年费用低于非多学科护理组（2372美元vs 3794美元，P <0.001）。此外，考虑到需要肾脏替代治疗的患者减少，多学科护理计划节省了每名患者每年1931美元。结论：我们的分析表明，多学科护理计划提供了更好的医疗保健和减少肾脏替代治疗的晚期慢性肾脏病患者。通过减少住院、急诊和肾脏替代治疗的需要，多学科护理计划具有成本效益。(c)2015作者爱思唯尔公司出版
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 non-multidisciplinary 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 m(2), 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. (c) 2015 The Authors. Published by Elsevier Inc.