Table 2 Studies Comparing Interdisciplinary Care Models to Standard Nephrology Care for Mortality, Hospitalizations and Renal Outcomes
From: Interdisciplinary care clinics in chronic kidney disease
Study, year | Study population and design | Exposure or intervention | Outcomes | Major findings | Cost-benefit |
|---|---|---|---|---|---|
Curtis et al., 2003 [63] | Retrospective cohort study of 288 incident dialysis patients (mean age 62 years) in Canada and Italy | Formalized multidisciplinary clinic programs consisting of a nurse educator, physician, social worker, nutritionist, and pharmacist | Mortality up to 2.5 years after dialysis initiation | HR 0.46 (95 % CI 0.23–0.90) for IDC group after adjustments for age, sex, calculated GFR at dialysis start, race, diabetes, etiology of kidney failure, and country of treatment | Not assessed |
Goldstein et al., 2004 [12] | Retrospective cohort study of 184 Canadian incident dialysis patients (mean age 60 years) | Progressive multidisciplinary renal disease clinic that included a dietitian, nurse educator, pharmacist, social worker and volunteer peer supporters | Mortality and hospitalizations at 1 year after starting dialysis | Fewer deaths in the IDC group (2 % versus 23 %; P < 0.01) and fewer hospitalizations (7 versus 69.7 days/patient/year (P < 0.01) | Not assessed |
Independent predictors of death were older age, history of cardiovascular disease and non-IDC. | |||||
Hemmelgarn et al., 2009 [61] | Propensity score matched cohort study of 6978 elderly Canadian patients (mean age 76 years) with CKD stage 4 and 5 | Multidisciplinary care clinic utilizing nurses, dietitians and social workers | 1. Mortality 2. All-cause and cardiovascular-specific hospitalizations | HR 0.50 (95 % CI 0.35–0.71) for the IDC group after adjustments for age, gender, baseline GFR, diabetes, and comorbidity score in the MDC group compared to standard group No difference in all-cause (HR 0.83; 95 % CI 0.64– 1.06) or cardiovascular-specific hospitalization (HR 0.76; 95 % CI 0.54 to 1.06) adjusted for age, gender, baseline GFR, diabetes, and comorbidity score | Not assessed |
Wu et al., 2009 [62] | Prospective cohort study of 573 Taiwanese patients (mean age 63 years) with GFR <60 ml/min/1.73 m2 | Multidisciplinary care with nurses for case management, dietitians, volunteer peer supporters | 1. Progression to ESRD | HR 0.117 (95 % CI 0.075–0.183) for the IDC group after adjustments for age, gender, DM and HTN status, baseline eGFR, hemoglobin and albumin | Not assessed |
2. All-cause mortality | HR 0.10 (95 % CI 0.04–0.265) for the IDC group after adjustments for gender, DM and HTN status, baseline eGFR, hemoglobin and albumin | ||||
Wei et al., 2010 [71] | Cohort study of 137 Taiwanese patients (mean age 57 control group and 63 exposed group) with CKD stage 3–5 | Multidisciplinary team including renal nurses and dieticians | Hospitalization for hemodialysis initiation | 40.8 % in the intervention group were not hospitalized compared to 18.8 % in the usual care group (P < 0.005) | Favored intervention |
Lacson et al., 2010 [64] | Matched (1:1) study of 2,800 incident dialysis (mean age 63 years) in the United States | Educational program on treatment options for dialysis | Mortality within the first 90 days of starting dialysis | HR 0.61 (95 % CI 0.50–0.74) for treatment options attendees compared to usual care after adjustments for case-mix and laboratory data | Not assessed |
Barrett et al., 2011 [69] CanPREVENT | Randomized control trial of 474 patients (mean age 67Â years) with CKD stage 3 and 4 in Canada | Nurse-coordinated care focused on risk factor modification | Rate of decline in GFR | Nurse-coordinated team did not alter rate of GFR decline | Not assessed |
Baylis et al., 2011 [68] | Cohort study of 2002 patients (mean age 68 years) with CKD stage 3 in the United States | Multidisciplinary team consisting of nephrologist, renal clinical pharmacy specialist, diabetes nurse educator, renal dietitian, social worker, and nephrology nurse | Rate of decline in GFR | Mean annual decline in GFR 1.73 ml/min/1.73 m2 in the intervention group compared to 2.1 ml/min/1.73 m2 in the usual care group after adjustments for nephrology site, follow-up time, race, age, baseline GFR, gender, number of chronic conditions, body mass index, number of GFR measurements, and number of primary care visit (P < 0.0001) | Not assessed |
Devins et al., 2011 [48] | Multi-center randomized control trial of 323 Canadian patients (mean age 54 years) with progressive CKD (deemed likely start dialysis in next 6 to 12 months) | Predialysis psychoeducation | Time to dialysis initiation | Median time to dialysis was 17.0 months in the intervention group compared to 14. 2 months in usual-care control group (P < 0.001) | Not assessed |
Van Zullen et al., 2012 [66] MASTERPLAN | Randomized control trial of 788 patients (mean age 59 years) from the Netherlands with CKD stage 3 and 4 | Addition of nurse practitioner coordinated care | 1. Composite of myocardial infarction, stroke, or cardiovascular death. | No difference (HR 0.90; 95 % CI 0.58–1.39) |  |
2. Composite vascular interventions, all-cause mortality or end-stage renal disease | No difference (HR 0.83; 95 % CI 0.57–1.20) | ||||
Peeters et al., 2014 [65] MASTERPLAN |  |  | 1. Composite of incident ESRD, death, or 50 % increase in creatinine | HR 0.80 (95 % CI 0.66–0.98) in the intervention group vs. control | Crude estimate of savings and costs favored intervention |
2. Difference in slope of GFR | Decrease in estimated GFR was 0.45 ml/min per 1.73 m2 per year less in intervention group vs. control (P = 0.01) |