Multidisciplinary Chronic Kidney Disease Clinic Practices: A Scoping Review

Abstract

Background:Multidisciplinary chronic kidney disease (CKD) clinics improve patient outcomes but their optimal design is unclear.Objective:To perform a scoping review to identify and describe current practices (structure, function) associated with multidisciplinary CKD clinics.Design:Scoping review.Setting:Databases included Medline, EMBASE, Cochrane, and CINAHL.Patients:Patients followed in multidisciplinary CKD clinics globally.Measurements:Multidisciplinary CKD clinic composition, entry criteria, follow-up, and outcomes.Methods:We systematically searched the literature to identify randomized controlled trials, non-randomized interventional studies, or observational studies of multidisciplinary CKD clinics defined by an outpatient setting where two or more allied health members (with or without a nephrologist) provided longitudinal care to 50 or more adult or pediatric patients with CKD. Included studies were from 2002 to present. Searches were completed on August 10, 2018. Title, abstracts, and full texts were screened independently by two reviewers with disagreements resolved by a third. We abstracted data from included studies to summarize multidisciplinary CKD clinic team composition, entry criteria, follow-up, and processes.Results:40 studies (8 randomized controlled trials and 32 non-randomized interventional studies or observational studies) involving 23 230 individuals receiving multidisciplinary CKD care in 12 countries were included. Thirty-eight focused on adults (27 with CKD, 10 incident dialysis patients, one conservative therapy) while two studies focused on adolescents or children with CKD. The multidisciplinary team included a mean of 4.6 (SD 1.5) members consisting of a nephrologist, nurse, dietician, social worker, and pharmacist in 97.4%, 86.8%, 84.2%, 57.9%, and 42.1% of studies respectively. Entry criteria to multidisciplinary CKD clinics ranged from glomerular filtration rates of 20 to 70 mL/min/1.73m2 or CKD stages 1 to 5 without any proteinuria or risk equation-based criteria. Frequency of follow-up was variable by severity of kidney disease. Team member roles and standardized operating procedures were infrequently reported.Limitations:Unstandardized definition of multidisciplinary CKD care, studies limited to CKD defined by glomerular filtration rate, and lack of representation from countries other than Canada, Taiwan, the United States, and the United Kingdom.Conclusions:There is heterogeneity in multidisciplinary CKD team composition, entry criteria, follow-up, and processes with inadequate reporting of this complex intervention. Additional research is needed to determine the best model for multidisciplinary CKD clinics.Trial registration:Not applicable.

A Randomized Controlled Trial to Evaluate and Assess the Effect of Comprehensive Pre-End Stage Kidney Disease Education on Home Dialysis Use in Veterans, Rationale and Design

“…Several cohort-based studies have shown the bene ts of CPE on a variety of pre-, and post-ESKD outcomes, including quality of CKD care, time to ESKD, vascular access outcomes, and pre-and post-ESKD survivals. [34,9,10] While not powered to detect differences in these outcomes, TEACH-VET will assess a variety of clinical, health services and patient-centered outcomes once these patients develop ESKD.…”

“…[8] Studies have further shown that provision of CPE improves patient awareness and is associated with bene cial impacts on several pre-, and post-ESKD outcomes. [9,10] In recent times, we and others have shown that provision of a formal protocol-based CPE, incorporated within the clinical care or as a stand-alone service leads to greater home dialysis selection (50-74%) and use (30-62%) even among the US advanced CKD patients. [11,12] Nevertheless, provision of kidney disease education occurs uncommonly in the routine care of advanced CKD in the US.…”

Role, function and challenges of multidisciplinary centres for rare diseases exemplified for neurofibromatosis type 1 syndrome

“…Several reports have described the MTD clinics before [22] and tried to outline the structure and function of such clinics in order to improve patient outcomes, but significant heterogeneity exists in such clinics with regard to team composition, entry criteria, follow-up and a variability of processes. Therefore, this work is in need of standardization.…”

Who should be responsible for the care of advanced chronic kidney disease? Do the guidelines point to the end of nephrology follow-up of advanced CKD or are they the starting point for a new approach?

“…Three recent systematic reviews have also addressed this question. While the first two conclude that data indicate that the involvement of different professionals (nurses, primary care phsydsicians and others) has a positive effect, the third one, while acknowledging the advantages that have been reported, points out the heterogeneity of the studies published in terms of multidisciplinary CKD clinic composition, entry criteria, follow-up, and type of care [ 8 – 10 ].…”