title: Multidisciplinary care for poor patients with chronic kidney disease in Mexico.
abstract: Coordinated multidisciplinary care (MDC) could improve management and outcomes of patients with chronic kidney disease (CKD). We opened a nurse-led, MDC CKD clinic in Guadalajara, Mexico. We report the clinic's results between March 2008 and July 2011. The records of 353 patients with CKD stage 3 and 4 were reviewed. Data were collected prospectively. Mean age was 59.1±15.5 years; 54.4% were female and 63.7% were diabetic. We observed significant changes in the quality of care between baseline and follow-up. Compliance with practice guidelines for angiotensin II receptor blockers (ARB) and beta blockers increased from 30.6% to 46.6%, and from 11% to 19%, respectively; for statins from 41.4% to 80.3% for erythropoietin and calcium binders from 10.5% to 23.4%, and from 41.9 to 82.6%, respectively. At last visit, 90% of patients were on ACE inhibitors/ARB. Blood pressure <130/80 mm Hg increased from 23% to 38%. Serum glucose ⩽130 mg/dl increased from 54.4% to 67.7%. Serum cholesterol >160 mg/dl decreased from 64.8% to 60.3%. At last visit, 70% of the patients had a serum Hgb ⩾11.0 g/dl, and 80.1% and 65.1% had a normal serum calcium and serum phosphate, respectively. In conclusion, we observed a trend in the improvement of quality of care of CKD patients similar to those reported by other MDC programs in the developed world. Our study demonstrated that a nurse-led MDC program could be successfully implemented in developing countries.
authors.affiliation: Division of Nephrology, Hospital Civil de Guadalajara, University of Guadalajara Health Sciences Center , Guadalajara, Jalisco, Mexico.
authors.forename: Guillermo
authors.initials: G
authors.lastname: Garcia-Garcia
authors.affiliation: Division of Nephrology, Hospital Civil de Guadalajara, University of Guadalajara Health Sciences Center , Guadalajara, Jalisco, Mexico.
authors.forename: Yolanda
authors.initials: Y
authors.lastname: Martinez-Castellanos
authors.affiliation: Division of Nephrology, Hospital Civil de Guadalajara, University of Guadalajara Health Sciences Center , Guadalajara, Jalisco, Mexico.
authors.forename: Karina
authors.initials: K
authors.lastname: Renoirte-Lopez
authors.affiliation: Division of Nephrology, Hospital Civil de Guadalajara, University of Guadalajara Health Sciences Center , Guadalajara, Jalisco, Mexico.
authors.forename: Alberto
authors.initials: A
authors.lastname: Barajas-Murguia
authors.affiliation: Division of Nephrology, Hospital Civil de Guadalajara, University of Guadalajara Health Sciences Center , Guadalajara, Jalisco, Mexico.
authors.forename: Librado
authors.initials: L
authors.lastname: de la Torre-Campos
authors.affiliation: Division of Nephrology, Hospital Civil de Guadalajara, University of Guadalajara Health Sciences Center , Guadalajara, Jalisco, Mexico.
authors.forename: Laura E
authors.initials: LE
authors.lastname: Becerra-Muñoz
authors.affiliation: OPD Hospitales Civiles de Guadalajara , Guadalajara, Jalisco, Mexico.
authors.forename: Jaime A
authors.initials: JA
authors.lastname: Gonzalez-Alvarez
authors.affiliation: Department of Medicine, University of Alberta , Edmonton, Alberta, Canada.
authors.forename: Marcello
authors.initials: M
authors.lastname: Tonelli
keywords: chronic kidney disease; outcomes; prevention