title: Progression of stages 3b-5 chronic kidney disease--preliminary results of Taiwan national pre-ESRD disease management program in Southern Taiwan.
abstract: OBJECTIVE
  The outcomes and their predictors, and rates of estimated glomerular filtration rate (eGFR) changes among Taiwanese, an ethnic Chinese population, with chronic kidney disease (CKD) stages 3b-5, enrolled in a nationwide pre-end-stage renal disease (pre-ESRD) management program that have not been previously reported.
  
  
  METHODS
  This study focused on a cohort of patients enrolled in the Taiwan's pre-ESRD disease management program from Southern Taiwan, including 4061 CKD 3b-5 patients who received more than 12 weeks of follow-up from 2007 to 2010. The decline rates of eGFR, outcomes, and the predictors of initiating dialysis were analyzed.
  
  
  RESULTS
  The study participants consisted of patients who were 70.1 ± 12.3 years old, of whom 56.4% were male, 46.3% were diabetic, and 72.1% were hypertensive. The mean annual eGFR changes were 0.47 ± 0.42 mL/min/1.73 m(2)/year, -1.27 ± 0.32 mL/min/1.73 m(2)/year, and -2.69 ± 0.39 mL/min/1.73 m(2)/year for stages 3b, 4, and 5, respectively; however, more rapid declines were noted in diabetic patients. The Kaplan-Meier analyses revealed that the probabilities of patients remaining alive and free of dialysis treatment for CKD stage 3b, 4, and 5 without or with diabetes were 89.46% versus 84.65%, 79.88% versus 55.68%, and 34.42% versus 9.64%, respectively, during 42 months of follow-up. Male gender, diabetes, lower baseline eGFR, higher systolic blood pressure, lower hematocrit, and albumin levels were the significant risk factors for initiating dialysis.
  
  
  CONCLUSIONS
  Even though we cannot conclude with certainty that the Taiwan pre-ESRD disease management program is beneficial in slowing the progression of CKD stages 3b-5, our preliminary results seem to suggest this trend. Furthermore, the program may be improved by integrating it with other programs, such as those on diabetes and hypertension, thus making it a more patient-centered, multidisciplinary program.
authors.affiliation: Bureau of National Health Insurance, Taipei, Taiwan.
authors.forename: Chun-Mei
authors.initials: CM
authors.lastname: Lin
authors.affiliation: Graduate Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan.
authors.forename: Ming-Chin
authors.initials: MC
authors.lastname: Yang
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
authors.forename: Shang-Jyh
authors.initials: SJ
authors.lastname: Hwang
authors.affiliation: Division of Nephrology, Department of Internal Medicine, National Cheng-Kung University Hospital, Tainan, Taiwan. Electronic address: jmsung@mail.ncku.ewdu.tw.
authors.forename: Junne-Ming
authors.initials: JM
authors.lastname: Sung
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003920:Diabetes Mellitus / Q000503:physiopathology; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000503:physiopathology* / Q000628:therapy*; D012307:Risk Factors; D015996:Survival Rate; D013624:Taiwan
keywords: chronic kidney disease; dialysis; disease management program; end-stage renal disease