Abstract
Background
Chronic kidney disease (CKD) has been identified as a growing global burden and traditional health care systems are inadequate for the management of CKD patients. This paper describes an initiative to establish a renal management clinic (RMC) in China and discusses the challenges and opportunities in the management of CKD patients.
Subjects and methods
We collected and analyzed the data for the first 1,000 CKD patients treated since the establishment of the RMC (from April 2006 to April 2007). They had CKD stages 1–4 and stage 5 (before dialysis), as described by the Kidney Outcome Quality Initiatives (KDOQI). They were managed at the RMC established at the Peking University Third Hospital, by a multidisciplinary team (nephrologists, nurses, and dietitians) who developed care plans, clinical pathways, and a multidimensional patient-education program.
Results
The most frequent causes of CKD among these 1,000 patient were glomerulonephritis (35%), hypertensive nephrosclerosis (19%), chronic interstitial nephritis (13%), and diabetic nephropathy (11%). Six percent of the patients had stage 1 CKD, 27% stage 2, 33% stage 3, 20% stage 4, and 13% had stage 5. Five hundred and fifty-four were male and 446 were female; mean age was 55 ± 18.9 years (range 18–92 years). Seven hundred and seventy patients (77%) had hypertension; 400 patients (40%) had body mass index (BMI) equal to or higher than 25 kg/m2; 180 (18%) had overt cardiovascular disease; 726 (72.6%) had low-density lipoprotein (LDL)-cholesterol higher than 2.6 mmol/l; 440 patients (44%) had hyperuriemia; and 274 patients (27.4%) had anemia (hemoglobin <110 g/l). Although the team is multidisciplinary, management of the patients in the RMC is undertaken mainly by nephrologists, whereas nurses and dietitians still do not play an important role. There are no family doctors in China and nephrologists are responsible for management of these patients’ kidney disease and related complications.
Conclusions
Our findings show that the prevalence of hypertension, diabetes mellitus, overweight. and hyperuricemia is high among Chinese CKD population. Nurses and dietitians do not yet play an important role in the present pattern of RMC. We believe that the present medical care model should be revised because it does not address the concerns of CKD patients and their need for lifestyle changes that would help them to cope with their chronic condition.
Similar content being viewed by others
References
Zhang LX, Zuo L, Xu GB, Wang F, Wang W, Wang SY et al (2007) Community-based screening for chronic kidney disease among populations older than 40 years in Beijing. Nephrol Dial Transplant 22:1093–1099. doi:10.1093/ndt/gfl763
Nissenson AR, Collins AJ, Hurley J, Petersen H, Pereira BJ, Steinberg EP (2001) Opportunities for improving the care of patients with chronic renal insufficiency: current practice patterns. J Am Soc Nephrol 12:1713–1720
Kausz AT, Khan SS, Abichandani R, Kazmi WH, Obrador GT, Ruthazer R et al (2001) Management of patients with chronic renal insufficiency in the Northeastern United States. J Am Soc Nephrol 12:1501–1507
Crooks P (2004) International care models for chronic kidney disease: methods and economics—United States. Blood Purif 22:13–20. doi:10.1159/000074919
Arora P, Mustafa RA, Karam J, Khalil P, Wilding G, Ranjan R et al (2006) Care of elderly patients with chronic kidney disease. Int Urol Nephrol 38(2):363–370. doi:10.1007/s11255-006-0046-x
Lindeman RD (2007) Hypertension and kidney protection in the elderly: what is the evidence in 2007? Int Urol Nephrol 39(2):669–678. doi:10.1007/s11255-007-9207-9
Zamboli P, De Nicola L, Minutolo R, Bertino V, Catapano F, Conte G (2006) Management of hypertension in chronic kidney disease. Curr Hypertens Rep 8:497–501. doi:10.1007/s11906-006-0029-4
Cook SA, Maclaughlin H, Macdougall IC (2008) A structured weight management programme can achieve improved functional ability and significant weight loss in obese patients with chronic kidney disease. Nephrol Dial Transplant 23:263–268. doi:10.1093/ndt/gfm511
Owen WF (2003) Patterns of care for patients with chronic kidney disease in the United States: dying for improvement. J Am Soc Nephrol 14:S76–S80. doi:10.1097/01.ASN.0000070145.00225.EC
Anand S, Nissenson AR (2002) Utilizing a disease management approach to improve ESRD patient outcomes. Semin Dial 15:38–40. doi:10.1046/j.1525-139x.2002.00012.x
Parker TF 3rd, Blantz R, Hostetter T, Himmelfarb J, Kliger A, Lazarus M et al (2004) The chronic kidney disease initiative. J Am Soc Nephrol 15:708–716. doi:10.1097/01.ASN.0000112129.20838.3F
Lameire N, Eknoyan G, Barsoum R, Eckardt KU, Levin A, Levin N et al (2004) The burden of kidney disease: improving global outcomes. Kidney Int 66:1310–1314. doi:10.1111/j.1523-1755.2004.00894.x
Peter WI, Schoolwerth AC, McGowan T, McClellan WM (2003) Chronic kidney disease: issues and establishing programs and clinics for improved patient outcomes. Am J Kidney Dis 41:903–924. doi:10.1016/S0272-6386(03)00188-4
National kidney foundation (2002) Clinical practice guidelines for chronic kidney disease: evaluation, classification and stratification. Am J Kidney Dis 39(Suppl 1):S1–S246
Covic A, Gusbeth-Tatomir P, Goldsmith DJ (2006) The epidemics of cardiovascular disease in elderly patients with chronic kidney disease—two facets of the same problem. Int Urol Nephrol 38(2):371–379. doi:10.1007/s11255-006-0044-z
Neves PL, Baptista A, Morgado E, Iglesias A, Carrasqueira H, Faísca M et al (2007) Anemia correction in predialysis elderly patients: influence of the antihypertensive therapy on darbepoietin dose. Int Urol Nephrol 39(2):685–689. doi:10.1007/s11255-006-9082-9
Silverberg DS, Wexler D, Iaina A, Steinbruch S, Wollman Y, Schwartz D (2006) Anemia, chronic renal disease and congestive heart failure-the cardio renal anemia syndrome: the need for cooperation between cardiologists and nephrologists. Int Urol Nephrol 38(2):295–310. doi:10.1007/s11255-006-0064-8
Spasovski GB (2007) Bone health and vascular calcifation relationships in chronic kidney disease. Int Urol Nephrol 39(4):1209–1216. doi:10.1007/s11255-007-9276-9
Grassmann A, Gioberge S, Moeller S, Brown G (2006) End-stage renal disease: global demographics in 2005 and observed trends. Artif Organs 30(12):895–897. doi:10.1111/j.1525-1594.2006.00321.x
Van Biesen W, Vanholder R, Veys N, Verbeke F, Delanghe J, De Bacquer D et al (2006) The importance of standardization of creatinine in the implementation of guidelines and recommendations for CKD: implications for CKD management programmes. Nephrol Dial Transplant 21(1):77–83. doi:10.1093/ndt/gfi185
Wei MX, Taskapan H, Esbaei K, Jassal SV, Bargman JM, Oreopoulos DG (2006) K/DOQI guideline requirements for calcium, phosphate, calcium phosphate product, and parathyroid hormone control in dialysis patients: can we achieve them? Int Urol Nephrol 38:739–743. doi:10.1007/s11255-005-0083-x
Covic A, Gusbeth-Tatomir P, Goldsmith DJ (2007) Current dilemmas in inhibiting the renin-angiotensin system: do not forget real life. Int Urol Nephrol 39:571–576. doi:10.1007/s11255-007-9211-0
Acknowledgements
Prof. Dimitrios G. Oreopoulos helped in the editing of this article and his assistance is greatly appreciated.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Zhang, AH., Zhong, H., Tang, W. et al. Establishing a renal management clinic in China: initiative, challenges, and opportunities. Int Urol Nephrol 40, 1053–1058 (2008). https://doi.org/10.1007/s11255-008-9450-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11255-008-9450-8