Effect of nephrology referrals and multidisciplinary care programs on renal replacement and medical costs on patients with advanced chronic kidney disease: A retrospective cohort study. Issue 33 (August 2019)

• Record Type: Journal Article
• Authors: Chen, Jui-Hsin; Chiu, Yi-Wen; Hwang, Shang-Jyh; Tsai, Jer-Chia; Shi, Hon-Yi; Lin, Ming-Yen
• Other Names: Phan. Phil section editor.
• Is Part Of: Medicine. Volume 98:Issue 33(2019)
• Publication Date: 2019-08
• Subjects: chronic kidney disease -- costs -- dialysis -- multidisciplinary care -- nephrology referral; Medicine -- Periodicals; Medicine -- Periodicals; Médecine -- Périodiques; Geneeskunde; Medicine; Periodicals; Periodicals; 610.5
• DOI: 10.1097/MD.0000000000016808
• Languages: English
• ISSNs: 0025-7974

Abstract

Abstract : Abstract: Evidence-based studies have revealed outcomes in patients with chronic kidney disease that differed depending on the design of care delivery. This study compared the effects of 3 types of nephrology care: multidisciplinary care (MDC), nephrology care, and non-nephrology care. We studied their effects on the risks of requiring dialysis and the differences between these methods had on long-term medical resource utilization and costs. We conducted a retrospective cohort study involving patients with an estimated glomerular filtration rate of (eGFR) ⩽45 mL/min/1.73 m 2 from 2005 to 2007. Patients were divided into MDC, non-MDC, and non-nephrology referral groups. Between-group differences with regard to the risk of requiring dialysis and annual medical utilization and costs were evaluated using a 5-year follow-up period. In total, 661 patients were included. After other covariates and the competing risk of death were taken into account, we observed a significant (56%) reduction in the incidence of dialysis in both the MDC and non-MDC groups relative to the non-nephrology referral group. Costs were markedly lower in the MDC group relative to the other groups (average savings: US$ 830 per year; 95% confidence interval: 367–1295; P < .001). For patients without nephrology referrals, MDC can substantially reduce their risk of developing end-stage renal disease and lower their medical costs. We therefore strongly advocate that all patients with an eGFR of ⩽45 mL/min/1.73 m 2 should be referred to a nephrologist and receive MDC. Abstract : Supplemental Digital Content is available in the text