Ten-year experience of an outpatient clinic for CKD-5 patients with multidisciplinary team and educational support

Vincenzo Terlizzi,Letizia Zeni,Luigi Manili,Annalisa Facchini,Valerio Vizzardi,Mattia Tonoli,Giovanni Cancarini,Massimo Sandrini

doi:10.1007/s11255-021-02963-y

Vincenzo Terlizzi, Letizia Zeni + Show 6 more

Open Access

https://doi.org/10.1007/s11255-021-02963-y

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Abstract

PurposeTo analyze the results of an outpatient clinic with a multidisciplinary team and educational support for patients with late-stage CKD (lsCKD), to check its possible effect on their outcomes.MethodsLongitudinal cohort study on patients followed up in the MaReA (Malattia Renale Avanzata = CKD5) outpatient clinic at ASST Spedali Civili of Brescia from 2005 to 2015 for at least six months. Trajectory of renal function over time has been evaluated only in those patients with at least four estimations of eGFR before referring to MaReA.ResultsSeven hundred and six patients were enrolled, their mean age was 72 ± 14 years, 59% were males. At the end of the study, 147 (21%) were still on MaReA, 240 (34%) on dialysis, 92 (13%) on very low-protein diet (VLPDs), 13 (2%) on pre-hemodialysis clinic, 23 (3%) improved renal function, 10 (1%) transplanted, 62 (9%) transferred/lost to follow-up, and 119 (17%) died. Optimal dialysis start (defined as start with definitive dialysis access, as an out-patient and without lsCKD complications) occurred in 180/240 (75%) patients. The results showed a slower eGFR decrease during MaReA follow-up compared to previous renal follow-up: − 2.0 vs. − 4.0 mL/min/1.73 m2 BSA/year (p < 0.05), corresponding to a median delay of 17.7 months in dialysis start in reference to our policy in starting dialysis. The patient cumulative survival was 75% after 24 months and 25% after 70. Limitations: (1) lack of a control group, (2) one-center-study, (3) about all patients were Caucasians.ConclusionThe follow-up of lsCKD patients on MaReA is associated with an optimal and delayed initiation of dialysis.

Highlights

The incidence and prevalence of chronic kidney disease (CKD) are progressively increasing worldwide [1]
The present longitudinal cohort study analyzes a 10-year experience in outpatient clinic dedicated to the End-Stage Kidney Disease ESKD with a multidisciplinary team and educational support
The high prevalence of CKD [1,2,3,4], the late referral to nephrologist and the chronic need of dialysis reduce the quality of life of patients and affect negatively healthcare costs

Summary

Introduction

The incidence and prevalence of chronic kidney disease (CKD) are progressively increasing worldwide [1]. In Italy, three studies on the prevalence of CKD show different results: CKD 3–5 stages account for 6% for patients aged 18–95 years in the GUBBIO Study[2], CKD1–4 12.3% in Giovanni Cancarini: Retired. Two factors could play impact positively on CKD outcomes: (a) early referral to nephrology care [8,9,10], (b) outpatient clinic evaluation by a multidisciplinary team, with exposure to educational program and cumulative “dose” of nephrological care. The present longitudinal cohort study analyzes a 10-year experience in outpatient clinic dedicated to the End-Stage Kidney Disease ESKD (in Italian: Malattia Renale Avanzata, MaReA) with a multidisciplinary team and educational support Several works have recently been devoted to these topics [7, 11,12,13,14,15].

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