title: Educational intervention in CKD retards disease progression and reduces medical costs for patients with stage 5 CKD.
abstract: BACKGROUND
  Nephrologist-based multidisciplinary care (MDC) has a positive impact on slowing chronic kidney disease (CKD) progression. However, the benefits of MDC in patients with stage 5 CKD remain unclear.
  
  
  METHODS
  Stage 5 CKD patients who visited the Chang Gung Memorial Hospital, Chiayi, Taiwan during the period of 2002-2008 were enrolled. The incident dialysis and medical cost were compared between MDC recipients and nonrecipients. The MDC recipients were divided into two groups by educational duration to observe the clinical renal outcome and medical care expenses. The effect of MDC on renal disease progression was also compared in MDC recipients with and without diabetes.
  
  
  RESULTS
  Out of 307 patients, 171 received MDC. For MDC recipients, the temporary usage of catheter was reduced (54.7% vs. 79.4%, p < 0.001), the hospital stay was shorter (18.64 ± 1.20 vs. 24.63 ± 1.22 months, p = 0.001), and the total medical cost was lower [New Taiwan dollars (NTD) 105,948.54 ± 9,967.22 vs. NTD 160,388.61 ± 16,373.97, p = 0.005] than for nonrecipients. Out of the 171 MDC recipients, those with MDC for more than 1 year had slower renal disease progression (0.76 ± 0.27 mL/min per 1.73 m(2) per year) and had an estimated per- capita annual cost savings of about NTD 336,500.66. MDC recipients with diabetes had a higher risk of requiring dialysis than those without diabetes.
  
  
  CONCLUSIONS
  MDC could significantly reduce temporary use of the catheter, hospital stay, and total medical costs in patients with stage 5 CKD. Furthermore, longer (>1 year) MDC could preserve renal function and deliver annual medical cost savings.
authors.affiliation: Department of Nephrology, Chang Gung Memorial Hospital, Chiayi, Taiwan.
authors.forename: Chen-Chou
authors.initials: CC
authors.lastname: Lei
authors.forename: Pei-Hsien
authors.initials: PH
authors.lastname: Lee
authors.forename: Yung-Chien
authors.initials: YC
authors.lastname: Hsu
authors.forename: Hung-Yu
authors.initials: HY
authors.lastname: Chang
authors.forename: Chun-Wu
authors.initials: CW
authors.lastname: Tung
authors.forename: Ya-Hsueh
authors.initials: YH
authors.lastname: Shih
authors.forename: Chun-Liang
authors.initials: CL
authors.lastname: Lin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017046:Cost Savings / Q000191:economics; D003695:Delivery of Health Care / Q000191:economics*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods*; D006435:Renal Dialysis / Q000191:economics*; D051436:Renal Insufficiency, Chronic / Q000191:economics / Q000628:therapy*; D012189:Retrospective Studies; D013624:Taiwan; D055815:Young Adult