Multidisciplinary care improves outcome of patients with stage 5 chronic kidney disease

摘要

Background and Objectives: Multidisciplinary care (MDC) is known to improve the management of chronic diseases. In this study, we investigated whether MDC improves outcomes in patients with advanced chronic kidney disease. Design, Setting, Participants and Measurements: In this retrospective case-control study we have compared the outcomes at the point of starting dialysis and beyond between a cohort of MDC patients (n = 171) and a cohort of nephrology patients (n = 194). The groups were well-matched demographically and were seen in the clinic for at least 3 months before starting dialysis. Dialysis access, blood pressure, haemoglobin, various biochemical parameters, hospital admissions, and survival were compared between the 2 groups. Results: In the MDC group, 68.4% started dialysis with permanent access compared with 58.8% in the nephrologist group (p = 0.04). The mean haemoglobin in the MDC group was 10.28 ± 1.86 versus 9.81 ± 1.76 g/dl in the nephrology group (p = 0.02). There was no difference between the groups in terms of blood pressure control or serum calcium, phosphate, or albumin levels. There were fewer hospital admissions in the MDC cohort (1.42 vs. 2.52 admissions per patient per year, p = 0.005). Kaplan-Meier survival analysis showed that patient survival was significantly better in the MDC group (p = 0.033). Conclusions: This study demonstrates that patients attending a multidisciplinary clinic are better prepared for dialysis treatment, have fewer hospital admissions after start of dialysis, and have a higher patient survival compared to those attending a traditional nephrology clinic.