Chronic kidney disease care program improves quality of pre-end-stage renal disease care and reduces medical costs.

摘要

AIM: Multidisciplinary care of patients with chronic kidney disease (CKD) provides better care outcomes. This study is to evaluate the effectiveness of a CKD care program on pre-end-stage renal disease (ESRD) care. METHODS: One hundred and forty incident haemodialysis patients were classified into the CKD Care Group (n = 71) and the Nephrologist Care Group (n = 69) according to participation in the CKD care program before dialysis initiation. The 'total observation period' was divided into '6 months before dialysis' and 'at dialysis initiation'. Quality of pre-ESRD care, service utilization and medical costs were evaluated and compared between groups. RESULTS: The mean estimated glomerular filtration rates at dialysis initiation were low in both groups; but the levels of haematocrit and serum albumin of the CKD Care Group were significantly higher. The percentages of patients initiating dialysis with created vascular access, without insertion of double-lumen catheter and without hospitalization were 57.7%, 50.7% and 40.8%, respectively, in the CKD Care Group, and 37.7%, 29.0% and 18.8% in the Nephrologist Care Group (P < 0.001). Participation in the CKD care program, though with higher costs during the 6 months before dialysis (Dollars US1428 +/- 2049 vs USDollars 675 +/- 962/patient, P < 0.001), was significantly associated with lower medical costs at dialysis initiation (Dollars US942 +/- 1941 vs Dollars US2410 +/- 2481/patient, P < 0.001) and for the total period of observation (Dollars US2674 +/- 2780 vs Dollars US3872 +/- 3270/patient, P = 0.009). The cost-saving effect came through the early preparation of vascular access and the lack of hospitalization at dialysis initiation. CONCLUSION: CKD care programs significantly improve quality of pre-ESRD care, decrease service utilization and save medical costs.