Association of pre-ESRD care education with patient outcomes in a 10-year longitudinal study of patients with CKD stages 3–5 in Taiwan

Chou, Chu-Lin; Chung, Chi‐Hsiang; Chiu, Hung-Wen; Liao, Chia‐Te; Wu, Chia-Chao; Hsu, Yung‐Ho; Chien, Wu-Chien

doi:10.1038/s41598-021-01860-9

Cited by 9 publications

(6 citation statements)

References 48 publications

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“…Within the Pre-ESRD P4P care program, nephrologists and CKD educators are required to collect data on smoking status. The P4P Pre-ESRD care program has been shown to lower the risks of both dialysis initiation and death 19 , 21 while improving patient outcomes, such as lower hemodialysis rates, fewer hospitalization events, and better overall survival 23 . Therefore, we conducted this study to examine the effect of smoking cessation within the Pre-ESRD P4P care program.…”

Section: Methodsmentioning

confidence: 99%

A quality improvement initiative for patients with chronic kidney disease to promote their smoking cessation

Chen,

Lin,

Hung

et al. 2023

Tob. Induc. Dis.

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Cigarette smoking is a critical issue in caring for patients of chronic kidney disease (CKD). However, there is no routine care program designed for combining both smoking cessation and CKD care. The process of our quality improvement (QI) collaboration used data under our routine payment-for-performance for pre-end-stage renal disease (P4P Pre-ESRD) in Taichung Veterans General hospital from 2020 to 2022. We share our experience with a QI project that integrates the Ottawa model for smoking cessation (OMSC) with the Pre-ESRD care program as part of routine CKD care. The electronic health information systems were improved to reduce workload of medical staff. The number was more for both qualified CKD educators and nephrologists for smoking cessation. The access and availability for smoking cessation were immediate and convenient for patients. Specifically, all the actions were performed by CKD educators, with nephrologists overseeing the process in routine care. By combining OMSC with the Pre-ESRD program, we were able to provide smokers with satisfactory access and availability to smoking cessation services within our healthcare facility. The smoker cases found were more in number (206 in 2020, 344 in 2021, and 421 in 2022). Before the integrated OSTC-Pre-ESRD program (in 2020), the proportion of smokers was 3.88%. After implementing the integrated program, smokers increased significantly on a yearly basis (9.69% in 2021 and 9.82% in 2022). Finally, case numbers of on-site smoking cessations increased significantly after implementing the integrated system (0 in 2020, 17 in 2021, and 20 in 2022). All CKD patients for smoking cessation were also more (8 in 2020, 46 in 2021, and 38 in 2022). After implementing the QI program, focusing on the integrated OMSC-Pre-ESRD program, we found more smokers undergoing smoking cessation. This QI program highlighted the importance of better access and availability for smoking cessation.

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Section: Methodsmentioning

confidence: 99%

A quality improvement initiative for patients with chronic kidney disease to promote their smoking cessation

Chen,

Lin,

Hung

et al. 2023

Tob. Induc. Dis.

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“…The Taiwan pre-ESRD program provides kidney care centered on the nephrologist and the multidisciplinary care team consisting of renal nurses, renal pharmacists, and dietitians (19,25). All non-dialysis patients with two serial serum creatinine examinations that reveal eGFR <45 may be eligible for enrollment into the program.…”

Section: Study Design and Participantsmentioning

confidence: 99%

“…The Taiwan nationwide pre-end-stage renal disease (pre-ESRD) pay-for-performance program (P4P) was implemented since 2006, with the aim to improve quality of CKD care in patients with CKD stages 3B, 4, and 5 (19)(20)(21). Centered on the nephrologist, the pre-ESRD program also combines the effort of a multidisciplinary care team consisting of renal nurses, renal pharmacists, and dietitians to provide kidney care.…”

Section: Introductionmentioning

confidence: 99%

Early Comprehensive Kidney Care in Dialysis-Requiring Acute Kidney Injury Survivors: A Populational Study

Liu

Chen

et al. 2022

Front. Med.

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BackgroundFor patients with Acute Kidney Injury (AKI), a strong and graded relationship exists between AKI severity and mortality. One of the most severe entities of AKI is Dialysis-Requiring Acute Kidney Injury (D-AKI), which is associated with high rates of mortality and end-stage renal disease (ESRD). For this high-risk population group, there is a lack of evidence regarding optimal post-AKI care. We propose that post-AKI care through the combined efforts of the nephrologist and the multidisciplinary care team may improve outcomes. Our aim here is to study for survivors of dialysis-requiring acute kidney injury, the effects of implementing early comprehensive kidney care.MethodsThis is a retrospective longitudinal cohort study of Taiwanese through analyzing the National Health Insurance Research Database (NHIRD). We included patients with acute dialysis during hospitalization from January 1, 2015 to December 31, 2018. Propensity match was done at 1:1, including estimated glomerular filtration rate (eGFR) based on CKD-EPI which was performed due to large initial disparities between these two cohorts.ResultsAfter the propensity match, each cohort had 4,988 patients. The mean eGFR based on CKD-EPI was 27.5 ml/min/1.73 m2, and the mean follow-up period was 1.4 years.The hazard ratio for chronic dialysis or ESRD was 0.55 (95% CI, 0.49–0.62; p < 0.001). The hazard ratio for all-cause mortality was 0.79 (95% CI, 0.57–0.88; p < 0.001). Both outcomes favored early comprehensive kidney care.ConclusionsFor survivors of dialysis-requiring acute kidney injury, early comprehensive kidney care significantly lowered risks of chronic dialysis and all-cause mortality.

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“…Follow-up and education on a regular 3-month basis are mandated for case payment. 30,31 According to the 2020 annual report, 63.9% of all patients undergoing dialysis were enrolled in the pe-ESRD program before dialysis initiation. 32 We included patients with stage 5 CKD who were not undergoing dialysis presenting in 2019 and 2020.…”

Section: Study Participantsmentioning

confidence: 99%

Air Pollution Alleviation During COVID-19 Pandemic is Associated with Renal Function Decline in Stage 5 CKD Patients

Wu¹,

Hsu²,

Chung³

et al. 2022

JMDH

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Introduction Air pollution is a novel environmental risk factor for chronic kidney disease (CKD). Air quality improved during COVID-19 lockdowns; however, the effects of these lockdowns on PM 2.5 concentrations and renal function remain unclear. Methods We conducted a retrospective cohort study to compare air pollution and estimated glomerular filtration rate (eGFR) decline in patients with stage 5 CKD between a year-long period of lockdown (2020; n = 724) and a similar period before lockdown (2019, n = 758). Results Compared with 2019, a 17.5% reduction in the average PM 2.5 concentration (from 17.36% to 14.32%; P < 0.001) and a 45.1% reduction (from 20.56% to 11.25%; P < 0.001) in cumulative days with PM 2.5 concentration >35 μg/m 3 were noted in 2020. Moreover, a 93% reduction in PM 2.5 air quality index >150 per station-day (from 0.43% to 0.03%) was observed in 2020. From 2019 to 2020, the yearly incidence of eGFR decline ≥5 mL/min/1.73 m 2 decreased by 33.7% (24.6% vs 16.3%; P < 0.001). Similarly, the proportion of patients who started undergoing regular dialysis also decreased by 32.7% in 2020 (from 20.8% to 14.0%; P = 0.001). Conclusion Our findings suggest that fewer events of renal function decline during the COVID-19 pandemic may be associated with a decline in PM 2.5 concentrations, supporting the global strategy of reducing air pollution to prevent CKD progression.

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Association of pre-ESRD care education with patient outcomes in a 10-year longitudinal study of patients with CKD stages 3–5 in Taiwan

Cited by 9 publications

References 48 publications

A quality improvement initiative for patients with chronic kidney disease to promote their smoking cessation

A quality improvement initiative for patients with chronic kidney disease to promote their smoking cessation

Early Comprehensive Kidney Care in Dialysis-Requiring Acute Kidney Injury Survivors: A Populational Study

Air Pollution Alleviation During COVID-19 Pandemic is Associated with Renal Function Decline in Stage 5 CKD Patients

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