476-P: Multidisciplinary Predialysis Team Education for Patients with Diabetic Nephropathy, Postponed Hemodialysis Induction, and Prolonged Survival after Hemodialysis Induction

Abstract

To determine whether a multidisciplinary team approach (MTA) improves the course of hemodialysis (HD), including clinical status, hospital admission costs, and prognosis after HD induction, in patients with diabetic nephropathy (DN), we compared the HD course of 36 patients who received MTA and 33 patients managed with a dietitian approach (DA) (n=69; 47 men: mean age, 59±12 years; 66 type 2 diabetic patients). HD started between January 2010 and June 2016. The observation period ended with death or in September 2018. MTA staff consisted of physicians, dietitians, nurses, laboratory technologists, and pharmacists. They provided broad education, including advice on nutrition, medication, medical examinations, and foot care. There were no significant differences in HbA1c, age, BMI, or eGFR between the groups when the baseline serum creatinine (S-Cr) was 2.0 mg/dL. There were no differences in the incidence of severe hypoglycemia or use of erythropoiesis-stimulating agents or RAS inhibitors. The MTA group was more likely to undergo 24-h urine collection than the DA group (likelihood ratio, 6.11; p=0.014). The MTA group had smaller CTR than the DA group (52.0% vs. 55.8%; p=0.024). Sodium intake based on 24-h urine collection was correlated with CTR (p=0.033). The MTA group had lower cost per admission for HD induction than the DA group ($20,580±14,170 vs. $14,804±8,397; p=0.023). Kaplan-Meier survival analysis showed that the MTA group had a longer duration from Cr 2.0 mg/dL to HD initiation (Wilcoxon 5.679; p=0.017) and from HD initiation to death than the DA group (Wilcoxon 3.860; p=0.050). MTA provided multiple broad effects with a longer duration before HD initiation, better clinical course, lower costs, and prolonged survival after HD induction compared with DA when observation started at the same S-Cr level. Future studies are needed to examine whether MTA has legacy effects after HD initiation. Disclosure M. Hitomi: None. T. Sato: None. T. Moriya: None.