Attitudes of Canadian Nephrologists Toward Multidisciplinary Team–Based CKD Clinic Care

Mendelssohn, David C.; Toffelmire, Edwin B.; Levin, Adeera

doi:10.1053/j.ajkd.2005.10.019

Cited by 51 publications

(39 citation statements)

References 21 publications

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“…173 The perception of Canadian nephrologists towards MDC-based CKD clinics has been presented in one survey. 159 More than 90% of nephrologists reported that MDC-based CKD clinics were easily accessible to them. Regarding decision-making on referral to MDC clinics, most (more than 80%) of the nephrologists found calculated creatinine clearance the most useful method rather than depending on estimated months before ESRD.…”

Section: Attitudes Of Patients/health-care Providersmentioning

confidence: 99%

See 1 more Smart Citation

Early referral strategies for management of people with markers of renal disease: a systematic review of the evidence of clinical effectiveness, cost-effectiveness and economic analysis

Black

Sharma²,

Scotland³

et al. 2010

Health Technol Assess

174

144

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How to obtain copies of this and other HTA programme reports An electronic version of this title, in Adobe Acrobat format, is available for downloading free of charge for personal use from the HTA website (www.hta.ac.uk). A fully searchable DVD is also available (see below).Printed copies of HTA journal series issues cost £20 each (post and packing free in the UK) to both public and private sector purchasers from our despatch agents.Non-UK purchasers will have to pay a small fee for post and packing. For European countries the cost is £2 per issue and for the rest of the world £3 per issue. How to order:-fax (with credit card details) -post (with credit card details or cheque) -phone during office hours (credit card only).Additionally the HTA website allows you to either print out your order or download a blank order form. Contact details are as follows:Synergie UK (HTA Department) Digital House, The Loddon Centre Wade Road Basingstoke Hants RG24 8QW Email: orders@hta.ac.uk Tel: 0845 812 4000 -ask for 'HTA Payment Services' (out-of-hours answer-phone service) Fax: 0845 812 4001 -put 'HTA Order' on the fax header Payment methods Paying by chequeIf you pay by cheque, the cheque must be in pounds sterling, made payable to University of Southampton and drawn on a bank with a UK address. Paying by credit cardYou can order using your credit card by phone, fax or post. SubscriptionsNHS libraries can subscribe free of charge. Public libraries can subscribe at a reduced cost of £100 for each volume (normally comprising 40-50 titles). The commercial subscription rate is £400 per volume (addresses within the UK) and £600 per volume (addresses outside the UK). Please see our website for details. Subscriptions can be purchased only for the current or forthcoming volume. How do I get a copy of HTA on DVD?Please use the form on the HTA website (www.hta.ac.uk/htacd/index.shtml). HTA on DVD is currently free of charge worldwide.The website also provides information about the HTA programme and lists the membership of the various committees. HTA NIHR Health Technology Assessment programmeT he Health Technology Assessment (HTA) programme, part of the National Institute for Health Research (NIHR), was set up in 1993. It produces high-quality research information on the effectiveness, costs and broader impact of health technologies for those who use, manage and provide care in the NHS. 'Health technologies' are broadly defined as all interventions used to promote health, prevent and treat disease, and improve rehabilitation and long-term care.The research findings from the HTA programme directly influence decision-making bodies such as the National Institute for Health and Clinical Excellence (NICE) and the National Screening Committee (NSC). HTA findings also help to improve the quality of clinical practice in the NHS indirectly in that they form a key component of the 'National Knowledge Service'. The HTA programme is needs led in that it fills gaps in the evidence needed by the NHS. There are three routes to the start of projects...

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Section: Attitudes Of Patients/health-care Providersmentioning

confidence: 99%

“…[159][160][161][162][163][164][165][166][167][168][169][170][171][172] Two broad categories of aspirations for care were described:…”

Section: Aspirational Model Of Carementioning

confidence: 99%

Early referral strategies for management of people with markers of renal disease: a systematic review of the evidence of clinical effectiveness, cost-effectiveness and economic analysis

Black

Sharma²,

Scotland³

et al. 2010

Health Technol Assess

174

144

View full text Add to dashboard Cite

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“…MDC clinics are being used by the majority of nephrology programs in North America (9), even though their effectiveness in improving morbidity and mortality outcomes for patients with CKD largely is unknown. Although observational studies suggested a survival advantage with MDC (10,11), these studies were limited to patients who initiated dialysis, thereby introducing a potential survival bias.…”

mentioning

confidence: 99%

Association between Multidisciplinary Care and Survival for Elderly Patients with Chronic Kidney Disease

Hemmelgarn¹,

Manns²,

Zhang³

et al. 2007

Journal of the American Society of Nephrology

158

117

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The effectiveness of multidisciplinary care (MDC) in improving health outcomes for patients with chronic kidney disease (CKD) is uncertain. This study sought to determine the association among MDC, survival, and risk for hospitalization among elderly outpatients with CKD. A total of 6978 patients who were 66 yr and older and had CKD were identified between July 1 and December 31, 2001, and followed to December 31, 2004; 187 (2.7%) were followed in an MDC clinic. Logistic regression was used to determine the propensity score (probability of MDC) for each patient, and MDC and non-MDC patients then were matched 1:1 on the basis of their score. A Cox model was used to determine the association between MDC and risk for death and hospitalization. After adjustment for age, gender, baseline GFR, diabetes, and comorbidity score, there was a 50% reduction in the risk for death for the MDC compared with the non-MDC group (hazard ratio [HR] 0.50; 95% confidence interval [CI] 0.35 to 0.71). There was no difference in the risk for all-cause (HR 0.83; 95% CI 0.64 to 1.06) or cardiovascularspecific hospitalization (HR 0.76; 95% CI 0.54 to 1.06) for the MDC compared with the non-MDC group. In conclusion, it was found that MDC was associated with a significant reduction in the risk for all-cause mortality and, although not statistically significant, a trend toward a reduction in risk for all-cause and cardiovascular-specific hospitalizations. The benefits of MDC and an assessment of their economic impact should be tested in a randomized, controlled trial.

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“…Most studies in the past had used 3-4 months as a definition of late referral for dialysis (1, 2, 3 and 5). In a survey of Canadian nephrologists, a majority thought 4-12 months in advance of RRT would be adequate interval to prepare patients (7). On the basis of our local experience, six months in advance of RRT was felt to be a reasonable length of time for patient's preparation.…”

Section: Dıscussıonmentioning

confidence: 91%

How do Patients who are Known to the Renal Units Start Chronic Haemodialysis?

Raza¹,

Dudley²

2011

Turk Neph Dial Transpl

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ıNTroDUCTıoN: A significant number of known ESRD patients start dialysis as an emergency. Key factors that determine emergency dialysis initiation have not been well identified. MATErıAl and MethoDS:Ninety out of 159 patients studied were known for> 6 months and divided into Emergency dialysis (EmG n=46) and Elective dialysis (EG n=44) groups. rESUlTS:Most diabetic patients started dialysis as an emergency (75% vs. 25% p=0.008). At the start, EmG had higher median urea (3.5 vs. 3.8 g/dl p=0.05), a lower bicarbonate (19 vs. 21.5 mEq/L, p=0.04) and haemoglobin (9.4 vs10.5 g/dl p=0.005).Three months pre-dialysis, EmG had a lower serum albumin (3.2 vs. 3.6 g/L, p=0.001) and haemoglobin (10.4 vs. 11, p=0.06), a higher CRP (21 vs. 5, p=0.08) and better preserved eGFR (11 vs. 9, p=0.001).In multivariate analysis, only a diagnosis of diabetes and a CRP >30 were independent risk factors for starting dialysis as an emergency. Having an albumin >3.5 was associated with a reduced risk of having an emergency start to dialysis. CoNClUSıoN:Apart from having diabetes, it seems difficult to predict emergency start of dialysis in known ESRD patients. Randomised controlled studies can further identify importance of high CRP and low serum albumin in relation to emergency initiation of dialysis.keY woRDS: Albumin, C Reactive protein, Emergency dialysis, Diabetes ÖZ GiriŞ: SDBY bulunduğu bilinen hastaların önemli bir kısmı diyalize acil şartlarda başlar. Diyalize acil şartlarda başlamayı belirleyen ana faktörler henüz tanımlanmamıştır. GErEÇ ve YÖnteMleR:Çalışılan 159 hastanın 90'ı > 6 aydır bilinmekteydi ve Acil diyaliz (EmG n=46) ve Elektif diyaliz (EG n=44) gruplarına bölündü.BUlGUlAr: Çoğu diyabetik hasta diyalize acil şartlarda başladı (%75 ve %25, p=0,008). Başlangıçta EmG grubunda medyan üre (3,5 ve 3,8 g/dl, p=0,05) daha yüksekti, bikarbonat (19 ve 21,5 mEq/L, p=0,04) ve hemoglobin (9,4 ve 10,5 g/dl, p=0,005) ise daha düşüktü.Diyalizden 3 ay önce EmG grubunda serum albumin (3,2 ve 3,6 g/L, p=0,001) ve hemoglobin (10,4 ve 11, p=0,06) daha düşüktü, CRP (21 ve 5, p=0,08) daha yüksekti ve eGFR (11 ve 9, p=0,001) daha iyi korunmuştu.Multivaryant analizde sadece diyabet tanısı ve CRP >30 diyalize acil şartlarda başlamak açısından bağımsız risk faktörleriydi. Albumin düzeyinin >3,5 g/L olması diyalize acil şartlarda başlanması riskinde bir azalmayla ilişkiliydi.SoNUÇ: Bilinen SDBY hastalarında diyabetli olmak dışında diyalize acil şartlarda başlanmasını öngörmek zor görünmektedir. Randomize kontrollü çalışmalar diyalize acil şartlarda başlanması açısından yüksek CRP ve düşük serum albumini bulunmasının önemini daha iyi tanımlayabilir.

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Attitudes of Canadian Nephrologists Toward Multidisciplinary Team–Based CKD Clinic Care

Cited by 51 publications

References 21 publications

Early referral strategies for management of people with markers of renal disease: a systematic review of the evidence of clinical effectiveness, cost-effectiveness and economic analysis

Early referral strategies for management of people with markers of renal disease: a systematic review of the evidence of clinical effectiveness, cost-effectiveness and economic analysis

Association between Multidisciplinary Care and Survival for Elderly Patients with Chronic Kidney Disease

How do Patients who are Known to the Renal Units Start Chronic Haemodialysis?

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