Research article
Impact of prior CKD management in a renal care network on early outcomes in incident dialysis patients: a prospective observational study
1 Département de Néphrologie, Hôpital Edouard Herriot, Hospices Civils de Lyon, Pavillon P 5 place d’Arsonval, Lyon Cedex 03 F-69437, France
2 2 Université de Lyon, Lyon F-69373, France
3 Réseau TIRCEL, Hôpital Edouard Herriot, Lyon Cedex 03, F-69437, France
4 Service de Néphrologie, Hôpital Nord, Saint Etienne, F-42055, France
5 Service de Néphrologie, Hôpital Dupuytren, Limoges Cedex, F-87042, France
6 Service de Néphrologie, Transplantation, Dialyse, Centre Hospitalo-Universitaire de Bordeaux, Bordeaux, F-33000, France
7 Université Victor Segalen, Bordeaux, F-33000, France
8 Service de Néphrologie, Hôpital Gabriel Montpied, F-63003, Clermont Ferrand Cedex 1, France
9 AURA Auvergne, Chamalières, F-63400, France
10 Service de Néphrologie, Hôpital Bichat, Paris Cedex 18, F-75877, France
11 Pôle IMER, Hospices Civils de Lyon, et EA Santé-Individus-Société, Université de Lyon, Lyon, F-69000, France
BMC Nephrology 2013, 14:41 doi:10.1186/1471-2369-14-41
Published: 20 February 2013Abstract
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/1,73m2 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.
