title: Nurse practitioners improve quality of care in chronic kidney disease: two-year results of a randomised study.
abstract: BACKGROUND
  Chronic kidney disease (CKD) is associated with increased cardiovascular risk. Here we evaluate whether strict implementation of guidelines aimed at multiple targets with the aid of nurse practitioners (NP) improves management in patients with CKD.
  
  
  METHODS
  MASTER PLAN is a randomised controlled clinical trial, performed in nine Dutch hospitals. Patients with CKD (estimated glomerular filtration rate (eGFR) 20-70 ml÷min) were randomised to receive NP support (intervention group (IG)) or physician care (control group (CG)). Patients were followed for a median of five years. Presented data are an interim analysis on risk factor control at two-year follow-up.
  
  
  RESULTS
  We included 788 patients (532 M, 256 F), (393 CG, 395 IG), mean (±SD ) age 59 (±13) years, eGFR 38 (±15) ml÷min÷1.73m(2), blood pressure (BP) 138 (±21)÷80 (±11) mmHg. At two years 698 patients (352 IG, 346 CG) could be analysed. IG as compared with CG had lower systolic (133 vs 135 mmHg&semi; p= 0.04) and diastolic BP (77 vs 80 mmHg&semi; p=0.007), LDL cholesterol (2.30 vs 2.45 mmol(-l); p= 0.03), and increased use of ACE inhibitors, statins, aspirin and vitamin D. The intervention had no effect on smoking cessation, body weight, physical activity or sodium excretion.
  
  
  CONCLUSIONS
  In both groups, risk factor management improved. However, changes in BP control, lipid management and medication use were more pronounced in IG than in CG. Lifestyle interventions were not effective. Coaching by NPs thus benefits everyday care of CKD patients. Whether these changes translate into improvement in clinical endpoints remains to be established.
authors.affiliation: Department of Nephrology, University Medical Center Utrecht, Utrecht, the Netherlands. a.vanzuilen@umcutrecht.nl
authors.forename: A D
authors.initials: AD
authors.lastname: van Zuilen
authors.forename: P J
authors.initials: PJ
authors.lastname: Blankestijn
authors.forename: M
authors.initials: M
authors.lastname: van Buren
authors.forename: M A G J
authors.initials: MA
authors.lastname: ten Dam
authors.forename: K A H
authors.initials: KA
authors.lastname: Kaasjager
authors.forename: G
authors.initials: G
authors.lastname: Ligtenberg
authors.forename: Y W J
authors.initials: YW
authors.lastname: Sijpkens
authors.forename: H E
authors.initials: HE
authors.lastname: Sluiter
authors.forename: P J G
authors.initials: PJ
authors.lastname: van de Ven
authors.forename: G
authors.initials: G
authors.lastname: Vervoort
authors.forename: L
authors.initials: L
authors.lastname: Vleming
authors.forename: M L
authors.initials: ML
authors.lastname: Bots
authors.forename: J F M
authors.initials: JF
authors.lastname: Wetzels
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000209:etiology / Q000517:prevention & control; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000451:nursing* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D009722:Nurse Practitioners; D011787:Quality of Health Care; D012307:Risk Factors; D040242:Risk Reduction Behavior; D016540:Smoking Cessation
chemical_list: D000959:Antihypertensive Agents; D000960:Hypolipidemic Agents