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Multidisciplinary care in patients with chronic kidney disease: A systematic review and meta-analysis

  • Su-Ming Wang
    Affiliations
    Kidney Institute and Division of Nephrology, China Medical University Hospital, Taichung, Taiwan

    College of Medicine, China Medical University, Taichung, Taiwan
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  • Lien-Cheng Hsiao
    Affiliations
    College of Medicine, China Medical University, Taichung, Taiwan

    Division of Cardiology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
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  • I-Wen Ting
    Affiliations
    Kidney Institute and Division of Nephrology, China Medical University Hospital, Taichung, Taiwan

    College of Medicine, China Medical University, Taichung, Taiwan
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  • Tung-Min Yu
    Affiliations
    College of Medicine, China Medical University, Taichung, Taiwan

    Division of Nephrology, Department of Medicine, Taichung Veterans General Hospital, Taiwan
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  • Chih-Chia Liang
    Affiliations
    Kidney Institute and Division of Nephrology, China Medical University Hospital, Taichung, Taiwan

    College of Medicine, China Medical University, Taichung, Taiwan
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  • Huey-Liang Kuo
    Affiliations
    Kidney Institute and Division of Nephrology, China Medical University Hospital, Taichung, Taiwan

    College of Medicine, China Medical University, Taichung, Taiwan
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  • Chiz-Tzung Chang
    Affiliations
    Kidney Institute and Division of Nephrology, China Medical University Hospital, Taichung, Taiwan

    College of Medicine, China Medical University, Taichung, Taiwan
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  • Jiung-Hsiun Liu
    Affiliations
    Kidney Institute and Division of Nephrology, China Medical University Hospital, Taichung, Taiwan

    College of Medicine, China Medical University, Taichung, Taiwan
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  • Che-Yi Chou
    Correspondence
    Corresponding author at: Kidney Institute and Division of Nephrology, Department of Internal Medicine, China Medical University Hospital, No. 2, Yu-der Road, North District, Taichung 40447, Taiwan. Tel.: +886 4 22052121 3483; fax: +886 4 22058883.
    Affiliations
    Kidney Institute and Division of Nephrology, China Medical University Hospital, Taichung, Taiwan

    College of Medicine, China Medical University, Taichung, Taiwan
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  • Chiu-Ching Huang
    Affiliations
    Kidney Institute and Division of Nephrology, China Medical University Hospital, Taichung, Taiwan

    College of Medicine, China Medical University, Taichung, Taiwan
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      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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      References

        • Wen C.P.
        • Cheng T.Y.
        • Tsai M.K.
        • Chang Y.C.
        • Chan H.T.
        • Tsai S.P.
        • et al.
        All-cause mortality attributable to chronic kidney disease: a prospective cohort study based on 462293 adults in Taiwan.
        Lancet. 2008; 371: 2173-2182
        • Ronksley P.E.
        • Hemmelgarn B.R.
        Optimizing care for patients with CKD.
        Am J Kidney Dis. 2012; 60: 133-138
        • Inglis S.C.
        • Pearson S.
        • Treen S.
        • Gallasch T.
        • Horowitz J.D.
        • Stewart S.
        Extending the horizon in chronic heart failure: effects of multidisciplinary, home-based intervention relative to usual care.
        Circulation. 2006; 114: 2466-2473
        • Ducharme A.
        • Doyon O.
        • White M.
        • Rouleau J.L.
        • Brophy J.M.
        Impact of care at a multidisciplinary congestive heart failure clinic: a randomized trials.
        CMAJ. 2005; 173: 40-45
        • Cole M.G.
        • McCusker J.
        • Bellavance F.
        • Primeau F.J.
        • Bailey R.F.
        • Bonnycastle M.J.
        • et al.
        Systematic detection and multidisciplinary care of delirium in older medical inpatients: a randomized trial.
        CMAJ. 2002; 167: 753-759
        • Kim M.M.
        • Barnato A.E.
        • Angus D.C.
        • Fleisher L.A.
        • Kahn J.M.
        The effect of multidisciplinary care teams on intensive care unit mortality.
        Arch Intern Med. 2010; 170: 369-376
        • Sidhom M.A.
        • Poulsen M.G.
        Multidisciplinary care in oncology: medicolegal implications of group decisions.
        Lancet Oncol. 2006; 7: 951-954
        • Fried B.J.
        • Leatt P.
        • Deber R.
        • Wilson E.
        Multidisciplinary teams in health care: lessons from oncology and renal teams.
        Healthc Manage Forum. 1988; 1: 28-34
        • Chen P.M.
        • Lai T.S.
        • Chen P.Y.
        • Lai C.F.
        • Yang S.Y.
        • Wu V.
        • et al.
        Multidisciplinary care program for advanced chronic kidney disease: reduces renal replacement and medical costs.
        Am J Med. 2015; 128: 68-76
        • Wu I.W.
        • Wang S.Y.
        • Hsu K.H.
        • Lee C.C.
        • Sun C.Y.
        • Tsai C.J.
        • et al.
        Multidisciplinary predialysis education decreases the incidence of dialysis and reduces mortality—a controlled cohort study based on the NKF/DOQI guidelines.
        Nephrol Dial Transplant. 2009; 24: 3426-3433
        • Curtis B.M.
        • Ravani P.
        • Malberti F.
        • Kennett F.
        • Taylor P.A.
        • Djurdjev O.
        • et al.
        The short- and long-term impact of multi-disciplinary clinics in addition to standard nephrology care on patient outcomes.
        Nephrol Dial Transplant. 2005; 20: 147-154
        • Chen Y.R.
        • Yang Y.
        • Wang S.C.
        • Chou W.Y.
        • Chiu P.F.
        • Lin C.Y.
        • et al.
        Multidisciplinary care improves clinical outcome and reduces medical costs for pre-end-stage renal disease in Taiwan.
        Nephrology (Carlton). 2014; 19: 699-707
        • Barrett B.J.
        • Garg A.X.
        • Goeree R.
        • Levin A.
        • Molzahn A.
        • Rigatto C.
        • et al.
        A nurse-coordinated model of care versus usual care for stage 3/4 chronic kidney disease in the community: a randomized controlled trial.
        Clin J Am Soc Nephrol. 2011; 6: 1241-1247
        • Peeters M.J.
        • van Zuilen A.D.
        • van den Brand J.A.
        • Bots M.L.
        • van Buren M.
        • Ten Dam M.A.
        • et al.
        Nurse practitioner care improves renal outcome in patients with CKD.
        J Am Soc Nephrol. 2014; 25: 390-398
        • Devins G.M.
        • Mendelssohn D.C.
        • Barre P.E.
        • Binik Y.M.
        Predialysis psychoeducational intervention and coping styles influence time to dialysis in chronic kidney disease.
        Am J Kidney Dis. 2003; 42: 693-703
        • Department of Health and Ageing
        Primary health care reform in Australia.
        Report to support Australia's First National Primary Health Care Strategy. 2009
        • Panic N.
        • Leoncini E.
        • de Belvis G.
        • Ricciardi W.
        • Boccia S.
        Evaluation of the endorsement of the preferred reporting items for systematic reviews and meta-analysis (PRISMA) statement on the quality of published systematic review and meta-analyses.
        PLoS One. 2013; 8: e83138
        • van Zuilen A.D.
        • Bots M.L.
        • Dulger A.
        • van der Tweel I.
        • van Buren M.
        • Ten Dam M.A.
        • et al.
        Multifactorial intervention with nurse practitioners does not change cardiovascular outcomes in patients with chronic kidney disease.
        Kidney Int. 2012; 82: 710-717
        • Hemmelgarn B.R.
        • Manns B.J.
        • Zhang J.
        • Tonelli M.
        • Klarenbach S.
        • Walsh M.
        • et al.
        Association between multidisciplinary care and survival for elderly patients with chronic kidney disease.
        J Am Soc Nephrol. 2007; 18: 993-999
        • Wei S.Y.
        • Chang Y.Y.
        • Mau L.W.
        • Lin M.Y.
        • Chiu H.C.
        • Tsai J.C.
        • et al.
        Chronic kidney disease care program improves quality of pre-end-stage renal disease care and reduces medical costs.
        Nephrology (Carlton). 2010; 15: 108-115
        • Cho E.J.
        • Park H.C.
        • Yoon H.B.
        • Ju K.D.
        • Kim H.
        • Oh Y.K.
        • et al.
        Effect of multidisciplinary pre-dialysis education in advanced chronic kidney disease: propensity score matched cohort analysis.
        Nephrology (Carlton). 2012; 17: 472-479
        • Chen Y.R.
        • Yang Y.
        • Wang S.C.
        • Chiu P.F.
        • Chou W.Y.
        • Lin C.Y.
        • et al.
        Effectiveness of multidisciplinary care for chronic kidney disease in Taiwan: a 3-year prospective cohort study.
        Nephrol Dial Transplant. 2013; 28: 671-682
        • Harris L.E.
        • Luft F.C.
        • Rudy D.W.
        • Kesterson J.G.
        • Tierney W.M.
        Effects of multidisciplinary case management in patients with chronic renal insufficiency.
        Am J Med. 1998; 105: 464-471
        • Yeoh H.H.
        • Tiquia H.S.
        • Abcar A.C.
        • Rasgon S.A.
        • Idroos M.L.
        • Daneshvari S.F.
        Impact of predialysis care on clinical outcomes.
        Hemodial Int. 2003; 7: 338-341
        • Rognant N.
        • Alamartine E.
        • Aldigier J.C.
        • Combe C.
        • Vendrely B.
        • Deteix P.
        • et al.
        Impact of prior CKD management in a renal care network on early outcomes in incident dialysis patients: a prospective observational study.
        BMC Nephrol. 2013; 14: 41
        • Fenton A.
        • Sayar Z.
        • Dodds A.
        • Dasgupta I.
        Multidisciplinary care improves outcome of patients with stage 5 chronic kidney disease.
        Nephron Clin Pract. 2010; 115: c283-c288
        • Yu Y.J.
        • Wu I.W.
        • Huang C.Y.
        • Hsu K.H.
        • Lee C.C.
        • Sun C.Y.
        • et al.
        Multidisciplinary predialysis education reduced the inpatient and total medical costs of the first 6 months of dialysis in incident hemodialysis patients.
        PLoS One. 2014; 9: e112820
        • Levin A.
        • Lewis M.
        • Mortiboy P.
        • Faber S.
        • Hare I.
        • Porter E.C.
        • et al.
        Multidisciplinary predialysis programs: quantification and limitations of their impact on patient outcomes in two Canadian settings.
        Am J Kidney Dis. 1997; 29: 533-540
        • Goldstein M.
        • Yassa T.
        • Dacouris N.
        • McFarlane P.
        Multidisciplinary predialysis care and morbidity and mortality of patients on dialysis.
        Am J Kidney Dis. 2004; 44: 706-714
        • Heaf J.
        Adynamic bone disease and malnutrition-inflammation-cachexia syndrome.
        Kidney Int. 2007; 71 ([author reply 7]): 1326
        • Kalantar-Zadeh K.
        Recent advances in understanding the malnutrition-inflammation-cachexia syndrome in chronic kidney disease patients: what is next?.
        Semin Dial. 2005; 18: 365-369
        • Kalantar-Zadeh K.
        • Gutekunst L.
        • Mehrotra R.
        • Kovesdy C.P.
        • Bross R.
        • Shinaberger C.S.
        • et al.
        Understanding sources of dietary phosphorus in the treatment of patients with chronic kidney disease.
        Clin J Am Soc Nephrol. 2010; 5: 519-530
        • Mason N.A.
        Polypharmacy and medication-related complications in the chronic kidney disease patient.
        Curr Opin Nephrol Hypertens. 2011; 20: 492-497
        • Salgado T.M.
        • Moles R.
        • Benrimoj S.I.
        • Fernandez-Llimos F.
        Pharmacists' interventions in the management of patients with chronic kidney disease: a systematic review.
        Nephrol Dial Transplant. 2012; 27: 276-292
        • Garcia-Garcia G.
        • Martinez-Castellanos Y.
        • Renoirte-Lopez K.
        • Barajas-Murguia A.
        • de la Torre-Campos L.
        • Becerra-Munoz L.E.
        • et al.
        Multidisciplinary care for poor patients with chronic kidney disease in Mexico.
        Kidney Int Suppl. 2013; 3 ([2011]): 178-183
        • Chen I.R.
        • Wang S.M.
        • Liang C.C.
        • Kuo H.L.
        • Chang C.T.
        • Liu J.H.
        • et al.
        Association of walking with survival and RRT among patients with CKD stages 3–5.
        Clin J Am Soc Nephrol. 2014; 9: 1183-1189
        • Ethier J.
        • Mendelssohn D.C.
        • Elder S.J.
        • Hasegawa T.
        • Akizawa T.
        • Akiba T.
        • et al.
        Vascular access use and outcomes: an international perspective from the Dialysis Outcomes and Practice Patterns Study.
        Nephrol Dial Transplant. 2008; 23: 3219-3226
        • Chanouzas D.
        • Ng K.P.
        • Fallouh B.
        • Baharani J.
        What influences patient choice of treatment modality at the pre-dialysis stage?.
        Nephrol Dial Transplant. 2012; 27: 1542-1547