Effect of chronic kidney diseases patients receiving multidisciplinary care on hospitalization and clinical outcome - 3 year prospective cohort study

Purpose: To evaluate hospitalization and clinical outcome of chronic kidney disease (CKD) between multidisciplinary care (MDC) or usual care. Method: This was a 3 year prospective cohort study during 2008 to 2011 year. The study subjects were collected from the five cooperation hospitals. 1,056 CKD subjects received MDC or usual care, aged 20-80 years old, estimated glomerular filtration rate (eGFR) between 10 and 60ml/min, and had been treated for other metabolic diseases were randomly matched at a ratio of 1:1 on propensity score with gender, age, eGFR, comorbidity diseases. Laboratory measurement, medication, hospitalization utilization and clinical outcome were collected. Result: Average follow-up time was 33.1 months. The mean age of our subjects was 65.1 years old (male, 64.8%). MDC group had higher prescription rate of angiotensin receptor blocker, phosphate binders and uric acid control agents, and was controlled better in intact parathyroid hormone. The progression of eGFR at late stage (stage 4, 5) was slower in MDC group than usual care group. MDC group had nearly fewer double-lumen catheter access at dialysis initiation (p=0.09). By March, 2011, using Cox regression, MDC group was associated with a 40% reduction in the risk of hospitalization for infection, a 70% increase in dialysis risk and a 51% reduction in patient mortality compared with usual care group. Conclusion: In a 3 year following study, MDC patients had better renal function control, superior medication according to DOQI guideline. After MDC intervention, CKD patients are likely to progress to dialysis before reaching death.