title: Unexpected Return for Follow-up During the First Year of Multidisciplinary Care May Be Predictive of Rapid Deterioration of Renal Function.
abstract: Multidisciplinary predialysis education and team care (MDC) may slow the decline in renal function in patients with chronic kidney disease (CKD). However, associations between unexpected return during MDC and progression of renal dysfunction have not been characterized in patients with CKD. Our study aimed to determine the association between exacerbation of renal dysfunction and the frequency of unexpected return during follow-up.A total of 437 patients with CKD receiving multidisciplinary care between January 2009 and June 2013 at the Shin-Kong Wu Ho-Su Memorial Hospital were included in this retrospective observational cohort study, and multiple imputations were performed for missing data. The predictor was the frequency of unexpected return for follow-up during the first year after entering MDC. Main outcome was monthly declines in estimated glomerular filtration rates (eGFR). Moreover, the demographic data, comorbidities, history of medication, and routine laboratory data for patients with CKD were collected.Among all patients, 59.7% were male, the mean age at initiation of MDC was 69.4 ± 13.2 years, and the duration of follow-up was 21.4 ± 3.3 months. The subjects were divided into 2 groups according to frequencies of follow-up (≤4 and > 4 visits) during the 1st year of MDC. The patients with CKD were regularly followed up every 3 months as a part of MDC in our hospital, and patients who returned for more than 4 follow-up visits were included in the unexpected return group. In crude regression analyses, unexpected return was significantly associated with higher monthly declines of eGFR (β = 0.092, 95% confidence interval, 0.014-0.170). This association remained after adjustments for multiple variables, and subgroup analyses of unexpected return showed that male gender, older age, CKD stage 1 to 3, hypertension, history of coronary artery disease, and use of renin-angiotensin system blockade were significantly associated with declines in renal function.In conclusion, unexpected return for follow-up during the 1st year of MDC was significantly associated with the deterioration of renal function.
authors.affiliation: From the Division of Nephrology, Department of Internal Medicine, Shin-Kong Wu Ho-Su Memorial Hospital (M-HT, Y-WF, LHW, XGY, J-GL); Fu-Jen Catholic University School of Medicine (J-GL); and Division of Biostatistics, Institutes of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan (M-HT).
authors.forename: Ming-Hsien
authors.initials: MH
authors.lastname: Tsai
authors.forename: Yu-Weil
authors.initials: YW
authors.lastname: Fang
authors.forename: Li Hui
authors.initials: LH
authors.lastname: Wang
authors.forename: Xiang Gin
authors.initials: XG
authors.lastname: You
authors.forename: Jyh-Gang
authors.initials: JG
authors.lastname: Leu
mesh_terms: D000367:Age Factors; D000368:Aged; D015897:Comorbidity; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007677:Kidney Function Tests; D008297:Male; D010348:Patient Care Team; D010353:Patient Education as Topic; D051436:Renal Insufficiency, Chronic / Q000503:physiopathology* / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D011795:Surveys and Questionnaires