title: Multifactorial intervention with nurse practitioners does not change cardiovascular outcomes in patients with chronic kidney disease.
abstract: Strict implementation of guidelines directed at multiple targets reduces vascular risk in diabetic patients. Whether this also applies to patients with chronic kidney disease (CKD) is uncertain. To evaluate this, the MASTERPLAN Study randomized 788 patients with CKD (estimated GFR 20-70 ml/min) to receive additional intensive nurse practitioner support (the intervention group) or nephrologist care (the control group). The primary end point was a composite of myocardial infarction, stroke, or cardiovascular death. During a mean follow-up of 4.62 years, modest but significant decreases were found for blood pressure, LDL cholesterol, anemia, proteinuria along with the increased use of active vitamin D or analogs, aspirin and statins in the intervention group compared to the controls. No differences were found in the rate of smoking cessation, weight reduction, sodium excretion, physical activity, or glycemic control. Intensive control did not reduce the rate of the composite end point (21.3/1000 person-years in the intervention group compared to 23.8/1000 person-years in the controls (hazard ratio 0.90)). No differences were found in the secondary outcomes of vascular interventions, all-cause mortality or end-stage renal disease. Thus, the addition of intensive support by nurse practitioner care in patients with CKD improved some risk factor levels, but did not significantly reduce the rate of the primary or secondary end points.
authors: Department of Nephrology, University Medical Center Utrecht, Utrecht, The Netherlands. a.vanzuilen@umcutrecht.nl
authors: Arjan D
authors: AD
authors: van Zuilen
authors: Michiel L
authors: ML
authors: Bots
authors: Arzu
authors: A
authors: Dulger
authors: Ingeborg
authors: I
authors: van der Tweel
authors: Marjolijn
authors: M
authors: van Buren
authors: Marc A G J
authors: MA
authors: Ten Dam
authors: Karin A H
authors: KA
authors: Kaasjager
authors: Gerry
authors: G
authors: Ligtenberg
authors: Yvo W J
authors: YW
authors: Sijpkens
authors: Henk E
authors: HE
authors: Sluiter
authors: Peter J G
authors: PJ
authors: van de Ven
authors: Gerald
authors: G
authors: Vervoort
authors: Louis-Jean
authors: LJ
authors: Vleming
authors: Peter J
authors: PJ
authors: Blankestijn
authors: Jack F M
authors: JF
authors: Wetzels
mesh_terms: D000368:Aged; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000097:blood / Q000401:mortality / Q000451:nursing* / Q000503:physiopathology / Q000517:prevention & control*; D003131:Combined Modality Therapy; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate; D019983:Guideline Adherence; D006801:Humans; D007668:Kidney / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000451:nursing / Q000517:prevention & control; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D009203:Myocardial Infarction / Q000401:mortality / Q000451:nursing / Q000517:prevention & control; D009426:Netherlands; D009722:Nurse Practitioners; D017410:Practice Guidelines as Topic; D011314:Preventive Health Services; D016016:Proportional Hazards Models; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000175:diagnosis / Q000401:mortality / Q000451:nursing* / Q000503:physiopathology / Q000628:therapy*; D018570:Risk Assessment; D012307:Risk Factors; D040242:Risk Reduction Behavior; D012720:Severity of Illness Index; D016540:Smoking Cessation; D020521:Stroke / Q000401:mortality / Q000451:nursing / Q000517:prevention & control; D013997:Time Factors; D016896:Treatment Outcome; D015431:Weight Loss
chemical_list: D002317:Cardiovascular Agents