254728 Effect of chronic kidney diseases patients receiving multidisciplinary care on hospitalization and clinical outcome - 3 year prospective cohort study

Monday, October 29, 2012

Yue-Ren Chen, Taiwan, ROC , Division of Nephrology, Changhua Christian Hospital, Changhua City, Taiwan
Yu Yang, Taiwan, ROC , Division of Nephrology, Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
Shu-Chuan Wang, Taiwan, ROC , Division of Nephrology, Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
Ping-Fang Chiu, Taiwan, ROC , Division of Nephrology, Internal Medicine, Changhua Christian Hospital, Changhua City, Taiwan
Wen-Yu Chou, Taiwan, ROC , Division of Nephrology, Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
Ching-Yuang Lin, Taiwan, ROC , College of Medicine, China Medical University, Taichung, Taiwan
Jer-Ming Chang, Taiwan, ROC , Division of Nephrology, Kaohsiung Municipal Hsiaokang Hospital, Kaohsiung, Taiwan
Tzen-Wen Chen, Taiwan, ROC , Division of Nephrology, Taipei Medical University Hospital, Taipei, Taiwan
Shyang-Hwa Ferng, Taiwan, ROC , Division of Nephrology, Cathay general hospital, Taipei, Taiwan
Chun-Liang Lin, Taiwan, ROC , Division of Nephrology, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
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.

Learning Areas:
Chronic disease management and prevention
Epidemiology
Program planning
Public health or related public policy
Public health or related research

Learning Objectives:
Our study demonstrate that CKD patients receiving MDC have better renal function control, superior medicine therapy and are likely to progress to dialysis before reaching death.

Keywords: Chronic Diseases, Mortality

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been the principal of chroic kidney diseases focusing on public health education, prevention and self-mangement.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.