title: Impact of prior CKD management in a renal care network on early outcomes in incident dialysis patients: a prospective observational study.
abstract: BACKGROUND
  Effective therapeutic strategies are available to prevent adverse outcomes in patients with chronic kidney disease (CKD) but their clinical results are hindered by unplanned implementation. Coordination of care emerges as a suitable way to improve patient outcomes. In this study, we evaluated the effect of planned and coordinated patient management within a dedicated renal care network comparatively to standard renal care delivered in nephrology departments of teaching hospitals.
  
  
  METHODS
  This observational matched cohort study included 40 patients with CKD stage 4-5 in the network group as compared with a control group of 120 patients matched for age, sex and diabetic status. Main outcome was a composite endpoint of death from cardiovascular cause and cardiovascular events during the first year after dialysis initiation.
  
  
  RESULTS
  There was no difference between the two groups neither for the primary outcome (40% vs 41%) nor for the occurrence of death from cardiovascular cause or cardiovascular events. Whereas the proportion of patients requiring at least one hospitalization was identical (83.3% vs 75%), network patients experienced less individual hospitalizations than control patients (2.3 ± 2.0 vs 1.6 ± 1.7) during the year before dialysis start. Patients of the network group had a slower renal function decline (7.7 ± 2.5 vs 4.9 ± 1.1 ml/min/1,73 m(2) per year; p=0.04).
  
  
  CONCLUSIONS
  In this limited series of patients, we were unable to demonstrate a significant impact of the coordinated renal care provided in the network on early cardiovascular events in incident dialysis patients. However, during the predialysis period, there were less hospitalizations and a slower slope of renal function decrease.
authors: Département de Néphrologie, Hôpital Edouard Herriot, Hospices Civils de Lyon, Pavillon P 5 place d'Arsonval, Lyon Cedex 03 F-69437, France.
authors: Nicolas
authors: N
authors: Rognant
authors: Eric
authors: E
authors: Alamartine
authors: Jean Claude
authors: JC
authors: Aldigier
authors: Christian
authors: C
authors: Combe
authors: Benoit
authors: B
authors: Vendrely
authors: Patrice
authors: P
authors: Deteix
authors: Pascal
authors: P
authors: Cluzel
authors: Laurent
authors: L
authors: Juillard
authors: François
authors: F
authors: Vrtovsnik
authors: Christelle
authors: C
authors: Maurice
authors: Sophie
authors: S
authors: Fave
authors: Maurice
authors: M
authors: Laville
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000401:mortality*; D019058:Community Networks / Q000706:statistics & numerical data*; D015897:Comorbidity; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D009398:Nephrology / Q000706:statistics & numerical data; D010346:Patient Care Management; D010347:Patient Care Planning; D011446:Prospective Studies; D006435:Renal Dialysis / Q000401:mortality*; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology* / Q000401:mortality*; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome