title: Prospective study of 2151 patients with chronic kidney disease under conservative treatment with multidisciplinary care in the Vale do Paraíba, SP.
abstract: BACKGROUND
  Chronic Kidney Disease (CKD) is common, severe and treatable. Its detection involves low cost tests.
  
  
  OBJECTIVE
  To evaluate the effect of a multidisciplinary (nephrologist, social worker, nurse, nutritionist, and psychologist) intervention comparing clinical and laboratory parameters in patients with CKD.
  
  
  METHODS
  A prospective study with 2,151 patients attended at the State Center for Kidney Diseases of the Vale do Paraiba, São Paulo, from February 2008 to March 2011. The kidney function was measured using albuminuria and estimated glomerular filtration rate (eGRF) using the MDRD formula The clinical outcomes were the occurrence of cardiovascular disease (CAD), hospitalization episodes, need of renal replacement therapy (RRT) and death.
  
  
  RESULTS
  Participants had a mean (range) age of 62 years (14-101), a mean follow-up of 546 days (90-1540) and the majority was in the stage 3 of CKD (59%). The most common primary diagnoses were hypertension (41.2%) and diabetes (32.4%). Mean blood pressure values at the beginning and at the end of treatment were 143 ± 26 mmHg x 87 ± 14 mmHg and 123 ± 16 mmHg x 79 ± 9 mmHg, respectively (p < 0.001); the eGRF decreased from 58.5 ± 31 ml/min. to 56.3 ± 23 ml/min (p < 0.01). Mean value of proteinuria decreased from 1.04 ± 1.44 g/day to 0.61 ± 1.12 g/day, p < 0.001, and the fasting glicemia decreased from 137 ± 73 mg/dl to 116 ± 42 mg/dl. One hundred and twenty-two patients (5.7%) had a CAD episode, the hospitalization rate was 6.6% (n = 143 patients), 7.3% patients died (n = 156), and 1.1% (n = 23) patients needed to start RRT. The risk of cardiovascular events, hospitalization, or death was inversely related to eGRF, and the rates of these events were low compared with the international literature.
  
  
  CONCLUSIONS
  The multidisciplinary care with well defined targets is effective for the preservation of renal function and reduction in morbidity and mortality of CKD patients.
authors.affiliation: State Center for the Treatment of Kidney Disease of the Vale do Paraiaaba-SP.
authors.forename: Eduardo de Paiva
authors.initials: Ede P
authors.lastname: Luciano
authors.forename: Paulo Sérgio
authors.initials: PS
authors.lastname: Luconi
authors.forename: Ricardo Cintra
authors.initials: RC
authors.lastname: Sesso
authors.forename: Claudio Santiago
authors.initials: CS
authors.lastname: Melaragno
authors.forename: Patrícia Ferreira
authors.initials: PF
authors.lastname: Abreu
authors.forename: Sandra Ferreira Stanisck
authors.initials: SF
authors.lastname: Reis
authors.forename: Rejane Maria Spindola
authors.initials: RM
authors.lastname: Furtado
authors.forename: Gilson Fernandes
authors.initials: GF
authors.lastname: Ruivo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000401:mortality / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult