Effectiveness of adherence to a renal health program in a health network in Peru

Abstract

OBJECTIVE: To evaluate the effectiveness of adherence to a multidisciplinary renal health program in reducing mortality and progression to hemodialysis. METHODS: We used a database that included patient monitoring (2013-2017), dialysis admissions and all cause of mortality in Peru. Adherence to the program was established by meeting minimum visits during the first year of monitoring. The outcome of interest was hemodialysis admissions or all cause-mortality. Kaplan-Meier curves, Log-Rank test and competing survival analysis methods were used to estimate the differential risk between adherent and non-adherent patients. RESULTS: A total of 20,354 participants was evaluated; 54.1% were male, 72.1 years old in average, 2.2 years average follow-up, and 15,279 (75.1%) belonged to the early stages (1 to 3a) of Chronic Kidney Disease. Adherence decreased the risk of renal replacement therapy in 41.0% (HR = 0.59, 95%CI 0.41–0.85) in the low-risk group and mortality in the high-risk group was 31.0% (HR = 0.69, 95%CI 0.57–0.83). CONCLUSIONS: The multidisciplinary care strategy with standardized assessments by stage is effective in reducing admission to .0when the patient is identified in early stages and in reducing mortality in advanced stages.

Cost-effectiveness analysis of a strategy to delay progression to dialysis and death among chronic kidney disease patients in Lima, Peru

“…None of the parametric survival distributions were able to capture this drop, given their tendency to fit a smooth decay [ 25 ]. The most likely reasons behind the drop in the survival curve was patients being lost at follow up, rather than a sudden increase in the mortality rate [ 8 ]. Considering this, our survival curves were calibrated to the core progression of the disease for both the transition to dialysis and death.…”

“…They obtained outpatient visits on-demand and subject to availability. Additional details about the characteristics of care in the intervention have been provided in previous published studies [ 7 ], as well as the main differences between the intervention and control groups [ 8 ].…”

“…For the intervention, we adjusted the survival curves by the estimated treatment effects; the hazard ratios found in the epidemiological study: 58% (HR = 0.42, 95% CI 0.21, 0.71) reduction in risk to progress to dialysis and no change in mortality risk (HR = 1, 95% CI 0.88, 1.13) [ 8 ]. Given that the target population of the epidemiological study and the CEA are the same, these treatment effect estimates have enough internal validity to create reliable results.…”

“…Considering that the mean age of the population of interest is around 60 years old [ 8 ], our model ran for 30 cycles, where each cycle represents one year, to accrue the lifetime health and economic consequences of the intervention. According to country-specific life tables, after 90 years of age, less than 10% of the Peruvian population would still be alive [ 15 ].…”

“…The efficacy of the RHP was evaluated in competitive-risk survival analysis [ 8 ]. This study showed an effectiveness of 58% in reducing the risk of progression to dialysis.…”