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Effect of multidisciplinary care of dialysis initiation for outpatients with chronic kidney disease

  • Nephrology - Original Paper
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Abstract

Background

The aim of comprehensive multidisciplinary care (MDC) by the chronic kidney disease (CKD) team is not only to prevent worsening renal function, but also provide education on the selection of renal replacement therapy (RRT) by shared decision making (SDM). The purpose of this study was to examine the effects of MDC for predialysis outpatients on dialysis therapy, especially with regard to peritoneal dialysis (PD).

Methods

This study evaluated 112 CKD patients who underwent dialysis at our hospital starting from 2012, with 53 outpatients receiving MDC from the CKD team and 59 outpatients not receiving MDC. Annual decreases in the estimated glomerular filtration rates (ΔeGFR), the duration from the time of intervention to dialysis initiation, the urgent dialysis rate using a temporary catheter, and the PD selection rate were compared and examined between the two groups. The ΔeGFR, the duration from intervention to PD initiation, and the PD retention rate were compared between 18 PD patients in the MDC group and 10 PD patients in the non-MDC group.

Results

The MDC group had a significantly lower ΔeGFR, significantly longer duration, and a significantly lower urgent dialysis initiation rate versus the non-MDC group. Moreover, there was a significantly higher PD selection rate, significantly prolonged duration, and significantly higher PD retention rate.

Conclusions

Multidisciplinary CKD team care for outpatients is effective in delaying the progression of CKD and avoiding the initiation of urgent dialysis; contributing to improved PD selectivity and continuity by SDM.

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Authors and Affiliations

  1. Department of Nephrology, Nissan Tamagawa Hospital, 4-8-1 Seta Setagaya-ku, Tokyo, 158-0095, Japan

    Yoshihiko Imamura & Yasunori Takahashi

  2. Department of Diabetes, Nissan Tamagawa Hospital, 4-8-1 Seta Setagaya-ku, Tokyo, 158-0095, Japan

    Satoru Uchida & Masateru Iwamoto

  3. Division of Nursing, Nissan Tamagawa Hospital, 4-8-1 Seta Setagaya-ku, Tokyo, 158-0095, Japan

    Rie Nakamura & Miki Yamauchi

  4. Division of Pharmacy, Nissan Tamagawa Hospital, 4-8-1 Seta Setagaya-ku, Tokyo, 158-0095, Japan

    Yuka Ogawara, Mikiko Goto & Kazuyo Takeba

  5. Division of Nutrition Management, Nissan Tamagawa Hospital, 4-8-1 Seta Setagaya-ku, Tokyo, 158-0095, Japan

    Naomi Yaguchi

  6. Division of Nephrology, Toho University Medical Center Ohashi Hospital, 2-22-36 Ohashi, Meguro-ku, Tokyo, 153-8515, Japan

    Nobuhiko Joki

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  1. Yoshihiko Imamura
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Correspondence to Yoshihiko Imamura.

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Conflict of interest

None of the authors has 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 2019-028].

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

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Imamura, Y., Takahashi, Y., Uchida, S. et al. Effect of multidisciplinary care of dialysis initiation for outpatients with chronic kidney disease. Int Urol Nephrol 53, 1435–1444 (2021). https://doi.org/10.1007/s11255-021-02787-w

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