Educational Intervention in CKD Retards Disease Progression and Reduces Medical Costs for Patients with Stage 5 CKD

Abstract

Background: Nephrologist-based multidisciplinary care (MDC) has a positive impact on slowing chronic kidney disease (CKD) progression. However, the benefits of MDC in patients with stage 5 CKD remain unclear. Methods: Stage 5 CKD patients who visited the Chang Gung Memorial Hospital, Chiayi, Taiwan during the period of 2002-2008 were enrolled. The incident dialysis and medical cost were compared between MDC recipients and nonrecipients. The MDC recipients were divided into two groups by educational duration to observe the clinical renal outcome and medical care expenses. The effect of MDC on renal disease progression was also compared in MDC recipients with and without diabetes. Results: Out of 307 patients, 171 received MDC. For MDC recipients, the temporary usage of catheter was reduced (54.7% vs. 79.4%, p < 0.001), the hospital stay was shorter (18.64 AE 1.20 vs. 24.63 AE 1.22 months, p ¼ 0.001), and the total medical cost was lower [New Taiwan dollars (NTD) 105,948.54 AE 9,967.22 vs. NTD 160,388.61 AE 16,373.97, p ¼ 0.005] than for nonrecipients. Out of the 171 MDC recipients, those with MDC for more than 1 year had slower renal disease progression (0.76 AE 0.27 mL/min per 1.73 m 2 per year) and had an estimated per-capita annual cost savings of about NTD 336,500.66. MDC recipients with diabetes had a higher risk of requiring dialysis than those without diabetes. Conclusions: MDC could significantly reduce temporary use of the catheter, hospital stay, and total medical costs in patients with stage 5 CKD. Furthermore, longer (>1 year) MDC could preserve renal function and deliver annual medical cost savings.

Factors Associated with the Choice of Peritoneal Dialysis in Patients with End-Stage Renal Disease

“…Before reaching the stage of dialysis-dependent ESRD, patients with chronic kidney disease (CKD) who receive early nephrology referral and multidisciplinary predialysis education (MPE) are associated with improved survival [ 11 , 12 ], cost savings [ 5 , 13 , 14 ], and a significantly increased PD selection rate [ 5 , 15 , 16 ]. Previous studies have shown that, when offered a choice, approximately half of patients with incident ESRD choose home-based therapies, including PD [ 9 , 17 ].…”

Care for chronic renal patients – Role of multidisciplinary education

“…Brief tours in dialysis facilities are highly suggested, and meetings or videos with expert patients are also useful. Even if education is time-consuming, the aforementioned benefits provide cost savings on the long run (4,20).…”

Analgesic use, parents’ clan, and coffee intake are three independent risk factors of chronic kidney disease in middle and elderly-aged population: a community-based study

“…The study authors have clearly demonstrated that a multifaceted patient-centered educational intervention in the predialysis period would help retard the progression of the deterioration of renal function and to prevent the progression and/or development of the complications associated with poor renal function. 17 The authors of this study also suggested that there is a cost-saving effect due to early preparation of vascular access and the lack of hospitalization at dialysis initiation. 17 As such, the study authors routinely implement a multidisciplinary care program in the community, especially in rural areas.…”

“…17 The authors of this study also suggested that there is a cost-saving effect due to early preparation of vascular access and the lack of hospitalization at dialysis initiation. 17 As such, the study authors routinely implement a multidisciplinary care program in the community, especially in rural areas. Of course, longterm follow-up will be required to determine whether such an intervention will increase awareness of CKD in the community and whether the people from the community who choose to modify their diet and lifestyle as a result of education can successfully increase awareness of CKD and decrease its occurrence.…”