Usefulness of multidisciplinary care to prevent worsening renal function in chronic kidney disease

  • Yoshihiko ImamuraEmail author
  • Yasunori Takahashi
  • Toshihide Hayashi
  • Masateru Iwamoto
  • Rie Nakamura
  • Mikiko Goto
  • Kazuyo Takeba
  • Makoto Shinohara
  • Shun Kubo
  • Nobuhiko Joki
Original article



Comprehensive education about lifestyle, nutrition, medications and other types of treatment is important to prevent renal dysfunction in patients with chronic kidney disease (CKD). However, the effectiveness of multidisciplinary care on CKD progression has not been evaluated in detail. We aimed to determine whether multidisciplinary care at our hospital could help prevent worsening renal function associated with CKD.


A total of 150 pre-dialysis CKD outpatients accompanied (n = 68) or not (n = 82) with diabetes mellitus (DM) were enrolled into this study. We assessed annual decreases in estimated glomerular filtration rates (ΔeGFR), and measured systolic blood pressure (SBP), diastolic blood pressure (DBP), hemoglobin (Hb), uric acid (UA), low-density lipoprotein cholesterol (LDL), hemoglobin A1c (HbA1c) values and urinary protein to creatinine ratios (UPCR) 12 months before and after multidisciplinary care. In addition, changes in the number of medications and prescription ratio before and after multidisciplinary care were assessed in 90 patients with CKD who could confirm their prescribed medications.


The ΔeGFR significantly improved between before and after multidisciplinary care from − 5.46 to − 0.56 mL/min/1.73 m2/year, respectively. The number of medications and prescription ratio showed no significant changes before and after multidisciplinary care. The ratios of improved ΔeGFR were found in 66.7% of all patients, comprising 63.1% of males and 76.9% of females, 64.8% without DM and 69.4% with DM. Values for UA, LDL, and HbA1c were significantly reduced among patients with improved ΔeGFR.


Comprehensive multidisciplinary care of outpatients might help prevent worsening renal function among patients with CKD.


Multidisciplinary care Nephrologist Nurse Dietitian Pharmacist eGFR 


Compliance with ethical standards

Conflict of interest

None of the authors have any conflicts of interest to declare in connection with this paper.

Ethical statement

This study complied with the Declaration of Helsinki (2013). The Ethics Committee for Clinical Research at Nissan Tamagawa Hospital approved the study protocol [Permission number TAMA 2017-013].

Informed consent

Written, informed consent was obtained from all participants in the study to publish their innominate data.


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Copyright information

© Japanese Society of Nephrology 2018

Authors and Affiliations

  • Yoshihiko Imamura
    • 1
    Email author
  • Yasunori Takahashi
    • 1
  • Toshihide Hayashi
    • 1
  • Masateru Iwamoto
    • 2
  • Rie Nakamura
    • 3
  • Mikiko Goto
    • 4
  • Kazuyo Takeba
    • 4
  • Makoto Shinohara
    • 5
  • Shun Kubo
    • 6
  • Nobuhiko Joki
    • 6
  1. 1.Department of NephrologyNissan Tamagawa HospitalTokyoJapan
  2. 2.Department of DiabetesNissan Tamagawa HospitalTokyoJapan
  3. 3.Division of NursingNissan Tamagawa HospitalTokyoJapan
  4. 4.Division of PharmacyNissan Tamagawa HospitalTokyoJapan
  5. 5.Division of Nutrition ManagementNissan Tamagawa HospitalTokyoJapan
  6. 6.Division of NephrologyToho University Ohashi Medical CenterTokyoJapan

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