Highlights
- •We reviewed current evidence of multidisciplinary care in patients with chronic kidney disease.
- •Professionals vary among studies of multidisciplinary care.
- •Limited evidences are currently available for the benefits of multidisciplinary care.
- •The survival benefit was mainly obtained from observational cohort studies.
Abstract
Background
Multidisciplinary care (MDC) was widely used in multiple chronic illnesses but the
effectiveness of MDC in patients with chronic kidney disease (CKD) was inconclusive.
The aim of this meta-analysis is to estimate the effectiveness of MDC for CKD.
Methods
We searched PubMed, Web of Science, Google Scholar, Cochrane Library, and China Journal
Full-text Database for relevant articles published in English or Chinese. Studies
investigating MDC and non-MDC in patients with CKD were included. Random effect model
was used to compare all-cause mortality, dialysis, risk of temporal catheterization,
and hospitalization in the two treatment entities.
Results
We analyzed 8853 patients of 18 studies in patients with CKD stages 3–5, aged 63 ± 12 years. MDC was associated with lower risk of all-cause mortality with an odds ratio
(OR) of 0.52 [95% confidence interval (CI): 0.44–0.88, p = 0.01], mainly in cohort studies. MDC was associated with a lower risk of starting
dialysis (p = 0.02) and lower risk of temporal catheterization for dialysis (p < 0.01). MDC was not associated with a higher chance of choosing peritoneal dialysis
(p = 0.18) or a lower chance of hospitalization for dialysis (p = 0.13).
Conclusions
Limited evidence from randomized controlled trials is currently available to support
the benefit of MDC in patients with CKD. MDC is associated with lower all-cause mortality,
lower risk of starting dialysis, and lower risk of temporal catheterization for dialysis
in cohort studies. MDC is not associated with a higher chance of choosing peritoneal
dialysis or a lower chance of hospitalization for dialysis. More studies are needed
to determine the optimal professional that should be included in MDC.
Keywords
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Article info
Publication history
Published online: July 14, 2015
Accepted:
July 2,
2015
Received in revised form:
July 1,
2015
Received:
April 24,
2015
Identification
Copyright
© 2015 European Federation of Internal Medicine. Published by Elsevier Inc. All rights reserved.
