Adherence to multidisciplinary care in a prospective chronic kidney disease cohort is associated with better outcomes

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Abstract

Introduction

The Renal Healthcare Program Uruguay (NRHP-UY) is a national, multidisciplinary program that provides care to chronic kidney disease (CKD) patients. In this study, we report the global results of CKD patient outcomes and a comparison between those treated at the NRHP-UY Units, with those patients who were initially included in the program but did not adhere to follow up.

Methods

A cohort of not-on dialysis CKD patients included prospectively in the NRHP-UY between October 1 ^st 2004 and September 30 ^th 2017 was followed-up until September 30 ^th 2019. Two groups were compared: a) Nephrocare Group: Patients who had at least one clinic visit during the first year on NRHP-UY (n = 11174) and b) Non-adherent Group: Patients who were informed and accepted to be included but had no subsequent data registered after admission (n = 3485). The study was approved by the Ethics Committee and all patients signed an informed consent. Outcomes were studied with Logistic and Cox´s regression analysis, Fine and Gray competitive risk and propensity-score matching tests.

Results

14659 patients were analyzed, median age 70 (60–77) years, 56.9% male. The Nephrocare Group showed improved achievement of therapeutic goals, ESKD was more frequent (HR 2.081, CI 95%1.722–2.514) as planned kidney replacement therapy (KRT) start (OR 2.494, CI95% 1.591–3.910), but mortality and the combined event (death and ESKD) were less frequent (HR 0.671, CI95% 0.628–0.717 and 0.777, CI95% 0.731–0.827) (p = 0.000) compared to the Non-adherent group. Results were similar in the propensity-matched group: ESKD (HR 2.041, CI95% 1.643–2.534); planned kidney replacement therapy (KRT) start (OR 2.191, CI95% 1.322–3.631) death (HR 0.692, CI95% 0.637–0.753); combined event (HR 0.801, CI95% 0.742–0.865) (p = 0.000).

Conclusion

Multidisciplinary care within the NRHP-UY is associated with timely initiation of KRT and lower mortality in single outcomes, combined analysis, and propensity-matched analysis.

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Most cited references 72

Record: found
Abstract: found
Article: not found

A new equation to estimate glomerular filtration rate.

Andrew Levey, Lesley Stevens, Christopher H Schmid … (2009)

Equations to estimate glomerular filtration rate (GFR) are routinely used to assess kidney function. Current equations have limited precision and systematically underestimate measured GFR at higher values. To develop a new estimating equation for GFR: the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Cross-sectional analysis with separate pooled data sets for equation development and validation and a representative sample of the U.S. population for prevalence estimates. Research studies and clinical populations ("studies") with measured GFR and NHANES (National Health and Nutrition Examination Survey), 1999 to 2006. 8254 participants in 10 studies (equation development data set) and 3896 participants in 16 studies (validation data set). Prevalence estimates were based on 16,032 participants in NHANES. GFR, measured as the clearance of exogenous filtration markers (iothalamate in the development data set; iothalamate and other markers in the validation data set), and linear regression to estimate the logarithm of measured GFR from standardized creatinine levels, sex, race, and age. In the validation data set, the CKD-EPI equation performed better than the Modification of Diet in Renal Disease Study equation, especially at higher GFR (P < 0.001 for all subsequent comparisons), with less bias (median difference between measured and estimated GFR, 2.5 vs. 5.5 mL/min per 1.73 m(2)), improved precision (interquartile range [IQR] of the differences, 16.6 vs. 18.3 mL/min per 1.73 m(2)), and greater accuracy (percentage of estimated GFR within 30% of measured GFR, 84.1% vs. 80.6%). In NHANES, the median estimated GFR was 94.5 mL/min per 1.73 m(2) (IQR, 79.7 to 108.1) vs. 85.0 (IQR, 72.9 to 98.5) mL/min per 1.73 m(2), and the prevalence of chronic kidney disease was 11.5% (95% CI, 10.6% to 12.4%) versus 13.1% (CI, 12.1% to 14.0%). The sample contained a limited number of elderly people and racial and ethnic minorities with measured GFR. The CKD-EPI creatinine equation is more accurate than the Modification of Diet in Renal Disease Study equation and could replace it for routine clinical use. National Institute of Diabetes and Digestive and Kidney Diseases.

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Record: found
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Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization.

Alan S Go, Glenn Chertow, Dongjie Fan … (2004)

End-stage renal disease substantially increases the risks of death, cardiovascular disease, and use of specialized health care, but the effects of less severe kidney dysfunction on these outcomes are less well defined. We estimated the longitudinal glomerular filtration rate (GFR) among 1,120,295 adults within a large, integrated system of health care delivery in whom serum creatinine had been measured between 1996 and 2000 and who had not undergone dialysis or kidney transplantation. We examined the multivariable association between the estimated GFR and the risks of death, cardiovascular events, and hospitalization. The median follow-up was 2.84 years, the mean age was 52 years, and 55 percent of the group were women. After adjustment, the risk of death increased as the GFR decreased below 60 ml per minute per 1.73 m2 of body-surface area: the adjusted hazard ratio for death was 1.2 with an estimated GFR of 45 to 59 ml per minute per 1.73 m2 (95 percent confidence interval, 1.1 to 1.2), 1.8 with an estimated GFR of 30 to 44 ml per minute per 1.73 m2 (95 percent confidence interval, 1.7 to 1.9), 3.2 with an estimated GFR of 15 to 29 ml per minute per 1.73 m2 (95 percent confidence interval, 3.1 to 3.4), and 5.9 with an estimated GFR of less than 15 ml per minute per 1.73 m2 (95 percent confidence interval, 5.4 to 6.5). The adjusted hazard ratio for cardiovascular events also increased inversely with the estimated GFR: 1.4 (95 percent confidence interval, 1.4 to 1.5), 2.0 (95 percent confidence interval, 1.9 to 2.1), 2.8 (95 percent confidence interval, 2.6 to 2.9), and 3.4 (95 percent confidence interval, 3.1 to 3.8), respectively. The adjusted risk of hospitalization with a reduced estimated GFR followed a similar pattern. An independent, graded association was observed between a reduced estimated GFR and the risk of death, cardiovascular events, and hospitalization in a large, community-based population. These findings highlight the clinical and public health importance of chronic renal insufficiency. Copyright 2004 Massachusetts Medical Society

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A Randomized Trial of Intensive versus Standard Blood-Pressure Control

Jackson T Wright, Jeff D. Williamson, Paul K. Whelton … (2015)

New England Journal of Medicine, 373(22), 2103-2116

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All references

Author and article information

Contributors

Pablo Rios:

ORCID: https://orcid.org/0000-0002-0778-822X

Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SoftwareRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing

Laura Sola: Role: ConceptualizationRole: Formal analysisRole: InvestigationRole: MethodologyRole: SupervisionRole: ValidationRole: Writing – review & editing

Alejandro Ferreiro:

ORCID: https://orcid.org/0000-0001-6819-8058

Role: Formal analysisRole: InvestigationRole: MethodologyRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – review & editing

Ricardo Silvariño:

ORCID: https://orcid.org/0000-0002-0416-2694

Role: ConceptualizationRole: InvestigationRole: MethodologyRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – review & editing

Verónica Lamadrid: Role: ConceptualizationRole: InvestigationRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – review & editing

Laura Ceretta: Role: ConceptualizationRole: InvestigationRole: MethodologyRole: ValidationRole: Writing – review & editing

Liliana Gadola:

ORCID: https://orcid.org/0000-0001-5041-4760

Emmanuel A. Burdmann: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS One

Journal ID (publisher-id): plos

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, CA USA )

ISSN (Electronic): 1932-6203

Publication date (Electronic): 14 October 2022

Publication date Collection: 2022

Volume: 17

Issue: 10

Electronic Location Identifier: e0266617

Affiliations

[1 ] Comisión Asesora de Programa de Salud Renal, Fondo Nacional de Recursos, Montevideo, Uruguay

[2 ] Departamento de Nefrología, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay

University of Sao Paulo Medical School, BRAZIL

Author notes

Competing Interests: The authors have declared that no competing interests exist

¶ List of Nephrologists reporting to the Programa de Salud Renal de Uruguay (NRHP-UY) is provided in the Acknowledgments.

* E-mail: lilianagad@ 123456gmail.com

Author information

Pablo Rios https://orcid.org/0000-0002-0778-822X

Alejandro Ferreiro https://orcid.org/0000-0001-6819-8058

Ricardo Silvariño https://orcid.org/0000-0002-0416-2694

Liliana Gadola https://orcid.org/0000-0001-5041-4760

Article

Publisher ID: PONE-D-21-28741

DOI: 10.1371/journal.pone.0266617

PMC ID: 9565398

PubMed ID: 36240220

SO-VID: 9db47457-9d0e-47e8-86fd-f64b25bc689f

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date received : 21 September 2021

Date accepted : 23 March 2022

Page count

Figures: 2, Tables: 6, Pages: 21

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Uruguayan Renal Healthcare Program received an ISN-COMGAN Research & Prevention Program Grant (2007–9) for its initial development.

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Data Availability All relevant Data are within the paper and its Supporting Information files.

Adherence to multidisciplinary care in a prospective chronic kidney disease cohort is associated with better outcomes

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Most cited references 72

A new equation to estimate glomerular filtration rate.

Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization.

A Randomized Trial of Intensive versus Standard Blood-Pressure Control

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