Multifactorial intervention with nurse practitioners does not change cardiovascular outcomes in patients with chronic kidney disease

Zuilen, Arjan D. van; Bots, Michiel L.; Dulger, Arzu; Tweel, Ingeborg van der; Buren, Marjolijn van; Dam, Marc A.G.J. ten; Kaasjager, Karin A H; Ligtenberg, Gerry; Sijpkens, Yvo W.J.; Sluiter, Henk E.; Ven, Peter J.G. van de; Vervoort, G.M.M.; Vleming, Louis‐Jean; Blankestijn, Peter J.; Wetzels, Jack F.M.

doi:10.1038/ki.2012.137

Cited by 85 publications

(121 citation statements)

References 45 publications

(42 reference statements)

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“…34 In a comparison between additional intensive nurse-practitioner support and nephrologist care, the blood pressure decrease in the intervention group was 3/2 mmHg more (P<0.001) than in the control group. 35 However, in a randomised trial in which patients were randomly assigned to a nurse-coordinated team in secondary care, or to usual care in general practice, no effect on cardiovascular risk-factor control or on clinical end points was found. 36 The opportunity to ask advice from a nephrologist has been studied in a shared care system in the UK.…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

Effect of shared care on blood pressure in patients with chronic kidney disease: a cluster randomised controlled trial

Haan¹,

Vervoort²,

Weel³

et al. 2013

Br J Gen Pract

104

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BackgroundChronic kidney disease (CKD) is highly prevalent in patients with diabetes or hypertension in primary care. A shared care model could improve quality of care in these patients AimTo assess the effect of a shared care model in managing patients with CKD who also have diabetes or hypertension. Design and settingA cluster randomised controlled trial in nine general practices in The Netherlands. MethodFive practices were allocated to the shared care model and four practices to usual care for 1 year. Primary outcome was the achievement of blood pressure targets (130/80 mmHg) and lowering of blood pressure in patients with diabetes mellitus or hypertension and an estimated glomerular filtration rate (eGFR)<60ml/min/1.73m 2 . ResultsData of 90 intervention and 74 control patients could be analysed. Blood pressure in the intervention group decreased with 8.1 (95% CI = 4.8 to 11.3)/1.1 (95% CI = −1.0 to 3.2) compared to −0.2 (95% CI = −3.8 to 3.3)/−0.5 (95% CI = −2.9 to 1.8) in the control group. Use of lipid-lowering drugs, angiotensin-system inhibitors and vitamin D was higher in the intervention group than in the control group (73% versus 51%, 81% versus 64%, and 15% versus 1%, respectively, [P = 0.004, P = 0.01, and P = 0.002]). ConclusionA shared care model between GP, nurse practitioner and nephrologist is beneficial in reducing systolic blood pressure in patients with CKD in primary care.

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Section: Comparison With Existing Literaturementioning

confidence: 99%

Effect of shared care on blood pressure in patients with chronic kidney disease: a cluster randomised controlled trial

Haan¹,

Vervoort²,

Weel³

et al. 2013

Br J Gen Pract

104

View full text Add to dashboard Cite

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“…10 In short, during the follow-up in the study, all events were adjudicated by an independent committee. Myocardial infarction was defined as acute chest pain or tightness, accompanied by evident and lasting new ischemic changes on an ECG or an established rise and fall pattern of cardiac enzymes.…”

Section: End Pointsmentioning

confidence: 99%

“…Design, rationale, and main findings of the study have been described in detail previously. [9][10][11] In short, CKD patients with an estimated creatinine clearance of 20 to 70 mL/min per 1.73 m 2 aged >18 years were included. Patients were randomized to a multifactorial approach for risk factor management by a nurse practitioner added to nephrologist care or to usual care by a nephrologist alone.…”

Section: Multifactorial Approach and Superior Treatment Efficacy In Rmentioning

confidence: 99%

Prevalence of Apparent Therapy-Resistant Hypertension and Its Effect on Outcome in Patients With Chronic Kidney Disease

et al. 2015

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New options recently became available for treatment of uncontrolled blood pressure. Information on the prevalence of therapy-resistant hypertension (TRH) in patients with chronic kidney disease and its consequences is relevant to balance risks and benefits of potential new therapies. Data of 788 patients with chronic kidney disease came from a multicenter study investigating the effect on outcome of an integrated multifactorial approach delivered by nurse practitioners added to usual care versus usual care alone. Blood pressure was measured at the office and during 30 minutes using an automated oscillometric device. Apparent TRH (aTRH) was defined as a blood pressure ≥130/80 mm Hg despite treatment with ≥3 antihypertensive drugs, including a diuretic or treatment with ≥4 antihypertensive drugs. Participants were followed up for the occurrence of myocardial infarction, stroke or cardiovascular mortality (composite cardiovascular end point) and end-stage renal disease. aTRH was present in 34% (office blood pressure) and in 32% (automated measurements). During 5.3 years of follow-up, 17% of patients with aTRH reached a cardiovascular end point and 27% reached end-stage renal disease. aTRH lead to a 1.5-fold higher risk (95% confidence interval, 0.8–3.0) of a cardiovascular end point compared with controlled hypertensives in multivariable-adjusted analysis. aTRH increased end-stage renal disease risk 2.3-fold (95% confidence interval, 1.4–3.7). During 4 years of follow-up, the prevalence of aTRH did not decline in either treatment group. The prevalence of aTRH is high in patients with chronic kidney disease even after optimization of nephrologist care. The presence of TRH is related to a substantially increased risk of renal and cardiovascular outcomes.

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“…12,13 We recently showed that intensified support by nurse practitioners also improved risk factor levels in patients with CKD. 14,15 However, the intervention did not significantly reduce the rate of cardiovascular events. 15 In this analysis, we evaluated the effect of the intervention on renal endpoints after extended follow-up.…”

mentioning

confidence: 99%

“…14,15 However, the intervention did not significantly reduce the rate of cardiovascular events. 15 In this analysis, we evaluated the effect of the intervention on renal endpoints after extended follow-up.…”

mentioning

confidence: 99%

Nurse Practitioner Care Improves Renal Outcome in Patients with CKD

Peeters

Zuilen

Brand

et al. 2014

Journal of the American Society of Nephrology

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113

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Treatment goals for patients with CKD are often unrealized for many reasons, but support by nurse practitioners may improve risk factor levels in these patients. Here, we analyzed renal endpoints of the Multifactorial Approach and Superior Treatment Efficacy in Renal Patients with the Aid of Nurse Practitioners (MASTERPLAN) study after extended follow-up to determine whether strict implementation of current CKD guidelines through the aid of nurse practitioners improves renal outcome. In total, 788 patients with moderate to severe CKD were randomized to receive nurse practitioner support added to physician care (intervention group) or physician care alone (control group). Median follow-up was 5.7 years. Renal outcome was a secondary endpoint of the MASTERPLAN study. We used a composite renal endpoint of death, ESRD, and 50% increase in serum creatinine. Event rates were compared with adjustment for baseline serum creatinine concentration and changes in estimated GFR were determined. During the randomized phase, there were small but significant differences between the groups in BP, proteinuria, LDL cholesterol, and use of aspirin, statins, active vitamin D, and antihypertensive medications, in favor of the intervention group. The intervention reduced the incidence of the composite renal endpoint by 20% (hazard ratio, 0.80; 95% confidence interval, 0.66 to 0.98; P=0.03). In the intervention group, the decrease in estimated GFR was 0.45 ml/min per 1.73 m 2 per year less than in the control group (P=0.01). In conclusion, additional support by nurse practitioners attenuated the decline of kidney function and improved renal outcome in patients with CKD.

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Multifactorial intervention with nurse practitioners does not change cardiovascular outcomes in patients with chronic kidney disease

Cited by 85 publications

References 45 publications

Effect of shared care on blood pressure in patients with chronic kidney disease: a cluster randomised controlled trial

Effect of shared care on blood pressure in patients with chronic kidney disease: a cluster randomised controlled trial

Prevalence of Apparent Therapy-Resistant Hypertension and Its Effect on Outcome in Patients With Chronic Kidney Disease

Nurse Practitioner Care Improves Renal Outcome in Patients with CKD

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