THE CLINICAL EPIDEMIOLOGY OF CARDIOVASCULAR DISEASES IN CHRONIC KIDNEY DISEASE: Applying Multiple Interventions in Chronic Kidney Disease

Barrett, Brendan

doi:10.1046/j.1525-139x.2003.16032.x

Cited by 17 publications

(7 citation statements)

References 152 publications

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“…This is evidenced by the proportion of patients seen by doctors and by the higher number of medical appointments involving different health professionals. This is compliant with the interdisciplinarity proposed by a number of studies, which show differences in CKD outcomes when comorbidities are treated by multiple disciplines [21][22][23].…”

Section: Discussionsupporting

confidence: 81%

Effectiveness of an Secondary Prevention Program in Chronic Kidney Disease

Delgado¹,

Jaramillo²,

Orozco³

et al. 2013

OJNeph

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Background: There are many programs which focus on late-stage chronic kidney disease (CKD), and it is considered that further evidence needs to be generated regarding the effectiveness of the programs used before renal replacement therapy. Study Design: A cohort study. Settings & Participants: Patients over 15 years of age who had been diagnosed with CKD according to the KDOQI (Kidney Disease Outcomes Quality Initiative) guidelines and who had undergone conventional treatment (CT) or a renal protection program (RPP). These were patients of two Colombian health insurance companies. Predictors: Age, sex, marital status, comorbidities, CKD stage, and clinical indicators. Outcomes: First CKD progression, and need for renal replacement therapy (RRT). Measures: Clinical marker. Results: The RPP is structurally and functionally different from the CT. It offers the interdisciplinary management of patients, a greater number of medical appointments, and patients start to receive treatment at younger ages and at earlier stages of their condition. The clinical markers of the patients following the RPP are within adequate ranges, and their renal function is less impaired, despite the differences in basal conditions. Upon finishing the study, we found that patients who received CT had a higher risk of receiving nephrotoxic drugs and not receiving nephroprotective drugs. The explanatory variables for the first progression were age, stage, history of dyslipidemia, and hemoglobin, potassium, and albumin levels. These variables, together with glycemia levels were also valid for RRT, except for history of dyslipidemia, as it was not significant. Upon adjusting for the explanatory variables, it was found that belonging to the RPP and attending more appointments had a protective effect in the process of controlling renal damage. Limitations: A possible selection bias. Conclusions: Belonging to a structured renal protection program is an effective way to keeping the clinical markers associated with renal impairment within normal ranges.

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Section: Discussionsupporting

confidence: 81%

Effectiveness of an Secondary Prevention Program in Chronic Kidney Disease

Delgado¹,

Jaramillo²,

Orozco³

et al. 2013

OJNeph

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“…[2] Strategies to reduce CKD-related complications, including progression to end-stage renal disease (ESRD), and death, such as glycemic control in persons with diabetes, blood pressure control, reduction of proteinuria, avoidance of nephrotoxic substances (such as non-steroidal anti-inflammatory drugs) and diet and lifestyle modifications, are well-known to clinicians. [3–5] Implementation of these CKD risk-modification behaviors requires not only clinician awareness, but also patient understanding and engagement in their health. [6]…”

Section: Introductionmentioning

confidence: 99%

Assessment of Printed Patient-Educational Materials for Chronic Kidney Disease

et al. 2013

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Background: Awareness of chronic kidney disease (CKD) is suboptimal among patients with CKD, perhaps due to poor readability of patient education materials (PEMs). We reviewed the suitability and readability of common PEMs that focused on 5 content areas: basics of CKD, risk factors for CKD development, risk factors for CKD progression, complications of CKD and self-management strategies to improve kidney health. Methods: Three reviewers (nephrologist, primary care physician, patient) used the Suitability Assessment of Materials to rate PEMs on message content/stimulation of learning, typography, visuals and layout and determined literacy level. Mean ratings were calculated for each PEM by content area and overall (superior = 70-100; adequate = 40-69; inadequate = <40). Linear regression was used to determine the impact of literacy level on mean rating. Results: We reviewed 69 PEMs from 19 organizations, divided into 113 content area sections. Most (79%) PEM sections were ‘adequate' (mean rating, 58.3%). Inclusion of patient-centered content and opportunities for patient interaction were associated with ‘superior' ratings. Mean ratings (SD) were similar across content areas: basics of CKD, 58.9% (9.1); risk factors for CKD development, 57.0% (12.3); risk factors for CKD progression, 58.5% (12.0); CKD complications, 62.3% (15.7), and self-management strategies, 62.2% (12.3). ≤6th grade literacy level (vs. >6th grade) was associated with an 11.7 point higher mean rating. Conclusion: Most PEMs for kidney disease were adequate. Outstanding PEMs shared characteristics of patient centeredness, a low literacy level, and patient interaction. Providers should be aware of strengths and limitations of PEMs when educating their patients about CKD.

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“…In patients with chronic kidney disease (CKD), it is felt that, because of their multiple co-morbidities and their need for several different services, coordinated involvement of different inter-disciplinary teams may improve clinical outcomes [8,9,10]. A large study involving elderly patients with CKD has shown a 50% reduction in all-cause mortality in those cared for by a multidisciplinary team (MDT) compared with non-MDC patients [11].…”

Section: Introductionmentioning

confidence: 99%

Multidisciplinary Care Improves Outcome of Patients with Stage 5 Chronic Kidney Disease

Fenton

Sayar²,

Dodds³

et al. 2010

Nephron Clin Pract

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Background and Objectives: Multidisciplinary care (MDC) is known to improve the management of chronic diseases. In this study, we investigated whether MDC improves outcomes in patients with advanced chronic kidney disease. Design, Setting, Participants and Measurements: In this retrospective case-control study we have compared the outcomes at the point of starting dialysis and beyond between a cohort of MDC patients (n = 171) and a cohort of nephrology patients (n = 194). The groups were well-matched demographically and were seen in the clinic for at least 3 months before starting dialysis. Dialysis access, blood pressure, haemoglobin, various biochemical parameters, hospital admissions, and survival were compared between the 2 groups. Results: In the MDC group, 68.4% started dialysis with permanent access compared with 58.8% in the nephrologist group (p = 0.04). The mean haemoglobin in the MDC group was 10.28 ± 1.86 versus 9.81 ± 1.76 g/dl in the nephrology group (p = 0.02). There was no difference between the groups in terms of blood pressure control or serum calcium, phosphate, or albumin levels. There were fewer hospital admissions in the MDC cohort (1.42 vs. 2.52 admissions per patient per year, p = 0.005). Kaplan-Meier survival analysis showed that patient survival was significantly better in the MDC group (p = 0.033). Conclusions: This study demonstrates that patients attending a multidisciplinary clinic are better prepared for dialysis treatment, have fewer hospital admissions after start of dialysis, and have a higher patient survival compared to those attending a traditional nephrology clinic.

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THE CLINICAL EPIDEMIOLOGY OF CARDIOVASCULAR DISEASES IN CHRONIC KIDNEY DISEASE: Applying Multiple Interventions in Chronic Kidney Disease

Cited by 17 publications

References 152 publications

Effectiveness of an Secondary Prevention Program in Chronic Kidney Disease

Effectiveness of an Secondary Prevention Program in Chronic Kidney Disease

Assessment of Printed Patient-Educational Materials for Chronic Kidney Disease

Multidisciplinary Care Improves Outcome of Patients with Stage 5 Chronic Kidney Disease

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