title: Nurse practitioner care improves renal outcome in patients with CKD.
abstract: Treatment goals for patients with CKD are often unrealized for many reasons, but support by nurse practitioners may improve risk factor levels in these patients. Here, we analyzed renal endpoints of the Multifactorial Approach and Superior Treatment Efficacy in Renal Patients with the Aid of Nurse Practitioners (MASTERPLAN) study after extended follow-up to determine whether strict implementation of current CKD guidelines through the aid of nurse practitioners improves renal outcome. In total, 788 patients with moderate to severe CKD were randomized to receive nurse practitioner support added to physician care (intervention group) or physician care alone (control group). Median follow-up was 5.7 years. Renal outcome was a secondary endpoint of the MASTERPLAN study. We used a composite renal endpoint of death, ESRD, and 50% increase in serum creatinine. Event rates were compared with adjustment for baseline serum creatinine concentration and changes in estimated GFR were determined. During the randomized phase, there were small but significant differences between the groups in BP, proteinuria, LDL cholesterol, and use of aspirin, statins, active vitamin D, and antihypertensive medications, in favor of the intervention group. The intervention reduced the incidence of the composite renal endpoint by 20% (hazard ratio, 0.80; 95% confidence interval, 0.66 to 0.98; P=0.03). In the intervention group, the decrease in estimated GFR was 0.45 ml/min per 1.73 m(2) per year less than in the control group (P=0.01). In conclusion, additional support by nurse practitioners attenuated the decline of kidney function and improved renal outcome in patients with CKD.
authors.affiliation: Department of Nephrology, Radboud University Medical Center, Nijmegen, The Netherlands;
authors.forename: Mieke J
authors.initials: MJ
authors.lastname: Peeters
authors.forename: Arjan D
authors.initials: AD
authors.lastname: van Zuilen
authors.forename: Jan A J G
authors.initials: JA
authors.lastname: van den Brand
authors.forename: Michiel L
authors.initials: ML
authors.lastname: Bots
authors.forename: Marjolijn
authors.initials: M
authors.lastname: van Buren
authors.forename: Marc A G J
authors.initials: MA
authors.lastname: Ten Dam
authors.forename: Karin A H
authors.initials: KA
authors.lastname: Kaasjager
authors.forename: Gerry
authors.initials: G
authors.lastname: Ligtenberg
authors.forename: Yvo W J
authors.initials: YW
authors.lastname: Sijpkens
authors.forename: Henk E
authors.initials: HE
authors.lastname: Sluiter
authors.forename: Peter J G
authors.initials: PJ
authors.lastname: van de Ven
authors.forename: Gerald
authors.initials: G
authors.lastname: Vervoort
authors.forename: Louis-Jean
authors.initials: LJ
authors.lastname: Vleming
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Blankestijn
authors.forename: Jack F M
authors.initials: JF
authors.lastname: Wetzels
mesh_terms: D000368:Aged; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D015415:Biomarkers; D008078:Cholesterol, LDL / Q000097:blood; D003404:Creatinine / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D009722:Nurse Practitioners / Q000706:statistics & numerical data*; D009819:Office Visits / Q000706:statistics & numerical data; D010348:Patient Care Team; D010820:Physicians; D011507:Proteinuria / Q000453:epidemiology / Q000209:etiology; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000451:nursing* / Q000628:therapy / Q000652:urine; D016896:Treatment Outcome; D014807:Vitamin D / Q000627:therapeutic use
chemical_list: D000959:Antihypertensive Agents; D015415:Biomarkers; D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D014807:Vitamin D; D003404:Creatinine; D001241:Aspirin