title: Effectiveness of multidisciplinary care for chronic kidney disease in Taiwan: a 3-year prospective cohort study.
abstract: BACKGROUND
  Previous studies have demonstrated that multidisciplinary pre-dialysis education and team care may slow the decline in renal function for chronic kidney disease (CKD). Our study compared clinical outcomes of CKD patients between multidisciplinary care (MDC) and usual care in Taiwan.
  
  
  METHODS
  In this 3-year prospective cohort study from 2008 to 2010, we recruited 1056 CKD subjects, aged 20-80 years, from five hospitals, who received either MDC or usual care, had an estimated glomerular filtration rate (eGFR) <60 mL/min, were matched one to one with the propensity score including gender, age, eGFR and co-morbidity diseases. The MDC team was under-cared based on NKF K/DOQI clinical practice guidelines and the Taiwanese pre-end-stage renal disease (ESRD) care program. The incidence of progression to ESRD (initiation of dialysis) and mortality was compared between two groups. We also monitored blood pressure control, the rate of renal function decline, lipid profile, hematocrit and mineral bone disease control.
  
  
  RESULTS
  Participants were prone to be male (64.8%) with a mean age of 65.1 years and 33.1 months of mean follow-up. The MDC group had higher prescription rates of angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (ACEI/ARB), phosphate binder, vitamin D3, uric acid lower agents and erythropoietin-stimulating therapy and better control in secondary hyperparathyroidism. The decline of renal function in advanced stage CKD IV and V was also slower in the MDC group (-5.1 versus -7.3 mL/min, P = 0.01). The use of temporary dialysis catheter was higher in the usual care group, and CKD patients under MDC intervention exhibited a greater willingness to choose peritoneal dialysis modality. A Cox regression revealed that the MDC group was associated with a 40% reduction in the risk of hospitalization due to infection, and a 51% reduction in patient mortality, but a 68% increase in the risk of initiation dialysis when compared with the usual care group.
  
  
  CONCLUSIONS
  MDC patients were found to have more effective medication prescription according to K/DOQI guidelines and slower renal function declines in advanced/late-stage CKD. After MDC intervention, CKD patients had a better survival rate and were more likely to initiate renal replacement therapy (RRT) instead of mortality.
authors.affiliation: Changhua Christian Hospital Yun Lin Branch, Changhua, Taiwan.
authors.forename: Yue-Ren
authors.initials: YR
authors.lastname: Chen
authors.forename: Yu
authors.initials: Y
authors.lastname: Yang
authors.forename: Shu-Chuan
authors.initials: SC
authors.lastname: Wang
authors.forename: Ping-Fang
authors.initials: PF
authors.lastname: Chiu
authors.forename: Wen-Yu
authors.initials: WY
authors.lastname: Chou
authors.forename: Ching-Yuang
authors.initials: CY
authors.lastname: Lin
authors.forename: Jer-Ming
authors.initials: JM
authors.lastname: Chang
authors.forename: Tzen-Wen
authors.initials: TW
authors.lastname: Chen
authors.forename: Shyang-Hwa
authors.initials: SH
authors.lastname: Ferng
authors.forename: Chun-Liang
authors.initials: CL
authors.lastname: Lin
mesh_terms: D000328:Adult; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000628:therapy*; D017582:Renal Replacement Therapy; D015996:Survival Rate; D013997:Time Factors; D055815:Young Adult
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors