title: Multidisciplinary predialysis care and morbidity and mortality of patients on dialysis.
abstract: BACKGROUND
  Multidisciplinary predialysis care results in fewer hospitalizations and more patients starting hemodialysis therapy with vascular access. Rigorous comparisons of the effect of different types of predialysis care on outcomes after the initiation of dialysis therapy are in their infancy. We hypothesized that outcomes after the initiation of dialysis therapy would be superior in patients receiving multidisciplinary predialysis care than in those receiving conventional care.
  
  
  METHODS
  All incident dialysis patients at our center who had received at least 3 months of specialist predialysis care were categorized according to whether they had attended the multidisciplinary Progressive Renal Disease Clinic (PRDC). Patients with a failed transplant, acute renal failure, or previous renal replacement therapy were excluded. We compared these groups at initiation and during 3 years of dialysis therapy.
  
  
  RESULTS
  At the start of dialysis therapy, patient demographics and residual renal function were similar. PRDC patients were more likely to have a functioning access and be administered angiotensin-converting enzyme inhibitors, iron supplements, and bicarbonate therapy and had greater serum albumin and serum calcium levels. PRDC patients had fewer hospitalizations at 1 year (7.0 versus 69.7 d/patient/y; P < 0.01) and during the study duration (10.8 versus 57.4 d/patient/y; P < 0.05). There were fewer deaths in the PRDC group at 1 year (2% versus 23%; P < 0.01) and during the study duration (21% versus 42%; P < 0.05). A history of cardiovascular disease, older age, and non-PRDC predialysis care independently predicted death on dialysis therapy.
  
  
  CONCLUSIONS
  Multidisciplinary predialysis care is associated with superior clinical outcomes after the start of dialysis therapy.
authors.affiliation: St Michael's Hospital, Toronto, Ontario, Canada. marc.goldstein@utoronto.ca
authors.forename: Marc
authors.initials: M
authors.lastname: Goldstein
authors.forename: Teraiza
authors.initials: T
authors.lastname: Yassa
authors.forename: Niki
authors.initials: N
authors.lastname: Dacouris
authors.forename: Philip
authors.initials: P
authors.lastname: McFarlane
mesh_terms: D000328:Adult; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D010043:Outcome and Process Assessment, Health Care; D010348:Patient Care Team; D016016:Proportional Hazards Models; D017582:Renal Replacement Therapy; D012189:Retrospective Studies; D016019:Survival Analysis