Multidisciplinary predialysis education decreases the incidence of dialysis and reduces mortality--a controlled cohort study based on the NKF/DOQI guidelines

Wu, I‐Wen; Wang, Shun-Yin; Hsu, Kuang‐Hung; Lee, Chin‐Chan; Sun, Chiao‐Yin; Tsai, Chi-Jen; Wu, Mai-Szu

doi:10.1093/ndt/gfp259

Cited by 156 publications

(146 citation statements)

References 26 publications

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“…28 In Taiwan, the rate of misdiagnosing CKD may have been modest since 2004, because a CKD prevention program has made nearly all patients with CKD diagnosis receive specialist consultation. [29][30][31] In light of this information, our validation shows fair reliability for CKD identification in this study. Identifying AKI by the dialysis procedure also introduced limitations.…”

Section: Study Strengths and Limitationssupporting

confidence: 61%

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Long-Term Risk of Coronary Events after AKI

Wu¹,

Huang

et al. 2014

Journal of the American Society of Nephrology

272

268

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The incidence rate of AKI in hospitalized patients is increasing. However, relatively little attention has been paid to the association of AKI with long-term risk of adverse coronary events. Our study investigated hospitalized patients who recovered from de novo dialysis-requiring AKI between 1999 and 2008 using patient data collected from inpatient claims from Taiwan National Health Insurance. We used Cox regression with time-varying covariates to adjust for subsequent CKD and ESRD after discharge. Results were further validated by analysis of a prospectively constructed database. Among 17,106 acute dialysis patients who were discharged, 4869 patients recovered from dialysis-requiring AKI (AKI recovery group) and were matched with 4869 patients without AKI (non-AKI group). The incidence rates of coronary events were 19.8 and 10.3 per 1000 person-years in the AKI recovery and non-AKI groups, respectively. AKI recovery associated with higher risk of coronary events (hazard ratio [HR], 1.67; 95% confidence interval [95% CI], 1.36 to 2.04) and all-cause mortality (HR, 1.67; 95% CI, 1.57 to 1.79) independent of the effects of subsequent progression to CKD and ESRD. The risk levels of de novo coronary events after hospital discharge were similar in patients with diabetes alone and patients with AKI alone (P=0.23). Our results reveal that AKI with recovery associated with higher long-term risks of coronary events and death in this cohort, suggesting that AKI may identify patients with high risk of future coronary events. Enhanced postdischarge follow-up of renal function of patients who have recovered from temporary dialysis may be warranted. The incidence rate of AKI in hospitalized patients is increasing 1 and the number of deaths associated with dialysis-requiring AKI has more than doubled. 2 In hospitalized patients, AKI results in increased in-hospital and posthospitalization resource use. 3 Currently, the incidence rate of dialysis-requiring AKI is higher than the rate of ESRD, and its annual growth rate is as high as 10% in the United States. 4 Along with the advances in critical care medicine and dialysis technologies, the probability of being discharged alive after temporary AKI has been rising among hospitalized patients. 5 It has been noticed

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Section: Study Strengths and Limitationssupporting

confidence: 61%

“…Reliability of ICD-9-CM codes for AKI and CKD was validated. [29][30][31] Investigation of AKI recovery effect was conducted across broad varieties of patient groups. Effects from timevarying covariates were inspected.…”

Section: Study Strengths and Limitationsmentioning

confidence: 99%

Long-Term Risk of Coronary Events after AKI

Wu¹,

Huang

et al. 2014

Journal of the American Society of Nephrology

272

268

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“…In addition to a study, which showed an improvement in the outcome of CKD patients, 4 a controlled cohort study 5 showed that the change in renal function of patients with CKD stages 3-5 was 0.008 AE 0.139 mL/ min per 1.73 m 2 per month while receiving the MDC during 12 months of the follow-up. Often the CKD patients were referred at an advanced stage of renal failure, only few months before or even a few weeks prior to ESRD.…”

Section: Introductionmentioning

confidence: 99%

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

Lei¹,

Lee²,

Hsu³

et al. 2012

Renal Failure

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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.

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“…La educación multidisciplinar prediálisis basado en las directrices NFK/DOQI puede disminuir la incidencias de diálisis y reducir la mortalidad en los pacientes con ERC en la etapa tardía (34) , y puede suponer un retraso en la progresión de la enfermedad renal (35) . A pesar de los beneficios demostrados que aporta esta intervención, en nuestro estudio, un porcentaje de pacientes inferior al 40% fueron atendidos en la consulta de enfermería en la etapa previa al inicio de la TSR.…”

Section: Discussionunclassified

Influencia de la consulta de enfermería de enfermedad renal crónica avanzada en pacientes que inician tratamiento renal sustitutivo

Rubio¹,

Asensio²,

Raventos

2014

Enferm Nefrol

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ResumenLa remisión precoz del paciente con enfermedad renal crónica avanzada al especialista y una atención nefrológica integrada y especializada en la etapa prediálisis, proporcionada por un equipo multidisciplinar, ha demostrado tener importantes beneficios sobre pacientes en fase avanzada de la enfermedad renal que inician tratamiento renal sustitutivo. Objetivo: determinar si existe riesgo de alteraciones a nivel físico, psicológico o de la calidad de vida en pacientes que inician terapia sustitutiva renal en función de si han tenido seguimiento nefrológico multidisciplinar en la etapa prediálisis. Material y métodos: estudio observacional trasversal analítico sobre una muestra de 90 pacientes que inician terapia sustitutiva renal. Resultados: El 86,5% de los pacientes estudiados fue seguido por el nefrólogo en la etapa prediálisis, solo el 37,8% de los pacientes fue atendido por la enfermera. El 27,8% de los pacientes mostraban elevados niveles de ansiedad al iniciar diálisis. No se encontraron diferencias en la calidad de vida relacionado con la salud entre pacientes seguidos o no por la enfermera en la etapa prediálisis. Conclusiones: Un porcentaje muy bajo de pacientes son seguidos en la consulta de enfermería prediálisis, no existiendo diferencias significativas en la calidad de vida relacionada con la salud entre ambos grupos. Si se encontraron diferencias significativas en cuanto a la ansiedad; el grupo de pacientes atendidos por la enfermera en la etapa prediálisis presentan mayores niveles de ansiedad que los no atendidos. No differences in quality of life associated with health among patients followed or not by the nurse in the predialysis phase were found. Conclusions: A very small percentage of patients are followed in predialysis nurses, with no significant differences in quality of life related to health between the two groups. If significant differences were found with regard to anxiety; the group of patients seen by the nurse in the predialysis stage have higher levels of anxiety that unattended. PALABRAS CLAVE KEYWORDS -ERCA -NURSING CONSULTATION -QUALITY OF LIFE -ANXIETY / DEPRESSION ORIGINAL IntroducciónLa enfermedad renal crónica (ERC) presenta para nuestra sociedad actual un grave problema de salud pública, tanto por su elevada incidencia y prevalencia

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Multidisciplinary predialysis education decreases the incidence of dialysis and reduces mortality--a controlled cohort study based on the NKF/DOQI guidelines

Abstract: MPE based on the NKF/DOQI guidelines may decrease the incidence of dialysis and reduce mortality in late-stage CKD patients.

Cited by 156 publications

References 26 publications

Long-Term Risk of Coronary Events after AKI

Long-Term Risk of Coronary Events after AKI

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

Influencia de la consulta de enfermería de enfermedad renal crónica avanzada en pacientes que inician tratamiento renal sustitutivo

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