Effectiveness of a multidisciplinary clinic in managing children with chronic kidney disease.
OBJECTIVE
Long-term outcome of patients with chronic kidney disease (CKD) correlates with adequacy of predialysis care. This is best provided in a multidisciplinary clinic that integrates the services of a nephrologist with other staff. There is limited data about such clinics in children. The Children's Hospital of Michigan established a Chronic Renal Insufficiency (CRI) clinic in 2002 to provide comprehensive care to children with CKD. These children receive care from a nephrologist, nurse clinician, transplant coordinator, dietician, social worker, and psychologist. The objective of the study was to compare outcome variables between patients from the CRI clinic and a general nephrology clinic.


METHODS
This was a retrospective chart review of 44 patients with CKD stages 2 to 4, who were managed in the general nephrology clinic (1996-2001, n = 20) or the CRI clinic (2002-2007, n = 24) for 1 yr before starting renal replacement therapy (RRT). Laboratory parameters, growth, and dialysis access type at time of RRT were compared between the two cohorts.


RESULTS
At RRT, patients from the CRI clinic had better hemoglobin, lower parathyroid hormone and calcium phosphorus product than patients followed in the general nephrology clinic. More patients from the general nephrology clinic had an unplanned initiation of dialysis compared with patients from the CRI clinic (50% versus 10.5%, P < 0.05).


CONCLUSIONS
This indicates that children followed in a multidisciplinary clinic have better outcome variables and are more likely to achieve K/DOQI targets at initiation of dialysis. They are better prepared for dialysis with electively planned catheter insertion or functioning arteriovenous grafts/fistulae.
Menon
Shina
S
Division of Pediatric Nephrology and Hypertension, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan 48201, USA.
Valentini
Rudolph P
RP
Kapur
Gaurav
G
Layfield
Sandra
S
Mattoo
Tej K
TK
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005919:Glomerular Filtration Rate; D006130:Growth Disorders / Q000451:nursing / Q000628:therapy; D006760:Hospitalization; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D009398:Nephrology; D017063:Outcome Assessment, Health Care; D010044:Outpatient Clinics, Hospital; D010348:Patient Care Team; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000451:nursing / Q000601:surgery / Q000628:therapy*; D012189:Retrospective Studies