Multidisciplinary Care Program for Advanced Chronic Kidney Disease: Reduces Renal Replacement and Medical Costs

Chen, Ping-Min; Lai, Tai‐Shuan; Chen, Ping Yu; Lai, Chun-Fu; Yang, Shan-Yi; Wu, Vin‐Cent; Chiang, Chih Kang; Kao, Tung‐Wei; Huang, Jenq‐Wen; Chiang, Wen‐Chih; Lin, Shuei‐Liong; Hung, Kuan‐Yu; Chen, Ming-Fong; Chu, Tah‐Hsiung; Wu, Ming; Wu, Kwan Dun; Tsai, Tun‐Jun

doi:10.1016/j.amjmed.2014.07.042

Cited by 100 publications

(94 citation statements)

References 20 publications

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“…Full-text of 44 articles was obtained for the analysis and 25 articles were excluded because the number of patients who died or commenced dialysis were not reported (n = 21, including 8 studies in Chinese), the composition of MDC team was not shown (n = 3), and a study from the same group of patients (n = 1) [14,18]. The final analysis conducted was based on 8853 patients of 18 studies with a mean age of 63 ± 12 years old [9][10][11][12][13][14][15][18][19][20][21][22][23][24][25][26][27][28][29].…”

Section: Literature Searchmentioning

confidence: 99%

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Multidisciplinary care in patients with chronic kidney disease: A systematic review and meta-analysis

Wang

Hsiao

Ting

et al. 2015

European Journal of Internal Medicine

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Section: Literature Searchmentioning

confidence: 99%

“…MDC had also been used in patients with CKD but the beneficial effects of MDC on CKD patients' clinical outcomes were controversial in the published studies. MDC was associated with lower all-cause mortality [9][10][11] and lower risk of dialysis [10,12] in some but not all studies [13][14][15].…”

Section: Introductionmentioning

confidence: 97%

Multidisciplinary care in patients with chronic kidney disease: A systematic review and meta-analysis

Wang

Hsiao

Ting

et al. 2015

European Journal of Internal Medicine

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“…The present study did not find notable benefits of adopting multidisciplinary pre-dialysis care approach on outcomes, as had been shown in several other reports in the same country [32,33,34]. The reason for such a discrepancy was not clear but could be related in part to varied study designs and patient populations.…”

Section: Discussionmentioning

confidence: 35%

Patterns of Dialysis Initiation Affect Outcomes of Incident Hemodialysis Patients

Chen

Wang

Hwang

et al. 2015

Nephron

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Aims: There is a trend toward deferring the initiation of chronic dialysis until absolutely indicated. This strategy, however, might lead to increased uncertainties in the timing of dialysis access creation prior to dialysis onset for patients approaching end-stage renal disease (ESRD), and the impact of which on hard end points remains largely unclear. We hereby investigated the effect of varied patterns of dialysis initiation on outcomes of new-onset hemodialysis (HD) patients. Methods: Four hundred sixty-two prospectively recruited patients were stratified into planned elective (n = 117, 25%), planned urgent (n = 65, 14%) or unplanned urgent (n = 280, 61%) starters based on the timing of access creation with respect to dialysis initiation. The outcome measures were all-cause mortality, hospitalization and access reconstruction over 2 years. Results: The mean estimated glomerular filtration rate (eGFR) was higher in the planned elective than in the planned urgent or unplanned urgent starters at access creation (5.3 vs. 4.4 or 4.3 ml/min/1.73 m²), but not at dialysis initiation (4.2 vs. 3.9 or 4.3 ml/min/1.73 m²). During the follow-up, the planned elective population exhibited the lowest rates of overall mortality and hospitalization, but not access reconstruction. Multivariate Cox's regression analysis showed that the planned urgent and the unplanned urgent groups, comparing to the planned elective population, displayed a greater risk of early death (hazards ratio [HR] 3.324, 95% CI 1.409-7.840; HR 2.510, 95% CI 1.177-5.355, respectively) and early hospitalization (sub-hazards ratio [SubHR] 2.238, 95% CI 1.530-3.274; SubHR 1.529, 95% CI 1.096-2.133, respectively). Conclusion: Incident ESRD patients undergoing planned elective start of HD, compared to their planned or unplanned urgent counterparts, showed reduced risk of overall mortality and hospitalization in the first 2 years after commencing long-term dialysis at a mean eGFR <5 ml/min/1.73 m².

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“…Several comorbidities of the EuroSCORE models are chronic diseases with well-known effects on a patient's life expectancy that are not removed with surgery [5], and Figure 4 shows that most of the associated diseases defined in the EuroSCORE II model also affect long-term survival. Chronic kidney failure and the need for dialysis are associated with higher rates of rehospitalization and death even for nonsurgical populations; and also chronic obstructive pulmonary disease, extracardiac arteriopathies, and diabetes mellitus are some of those diseases that affect long-term life expectancy and increase health costs [16][17][18]. Chronic heart failure at the time of surgery is expected to affect the outcomes beyond the immediate surgical results, as clearly demonstrated by poor outcomes of patients with compromised cardiac function [19].…”

Section: Commentmentioning

confidence: 99%

The Impact of EuroSCORE II Risk Factors on Prediction of Long-Term Mortality

Barili

Pacini

D’Ovidio

et al. 2016

The Annals of Thoracic Surgery

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The EuroSCORE II cannot be considered a direct estimator of long-term risk of death, as its performance fades for mortality at follow-up longer than 30 days. Nonetheless, it is nonlinearly associated with long-term mortality, and most of its variables are risk factors for long-term mortality. Hence, they can be used in a different algorithm to stratify the risk of long-term mortality after surgery.

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Multidisciplinary Care Program for Advanced Chronic Kidney Disease: Reduces Renal Replacement and Medical Costs

Cited by 100 publications

References 20 publications

Multidisciplinary care in patients with chronic kidney disease: A systematic review and meta-analysis

Multidisciplinary care in patients with chronic kidney disease: A systematic review and meta-analysis

Patterns of Dialysis Initiation Affect Outcomes of Incident Hemodialysis Patients

The Impact of EuroSCORE II Risk Factors on Prediction of Long-Term Mortality

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