Early Chronic Kidney Disease Care Programme delays kidney function deterioration in patients with stage I-IIIa chronic kidney disease: an observational cohort study in Taiwan

Abstract

Objectives: To investigate the effect of the Early Chronic Kidney Disease (CKD) Care Programme on CKD progression in patients with CKD stage I-IIIa.

Design: Observational cohort study.

Setting: Taipei Medical University Research Database from three affiliated hospitals.

Participants: Adult non-pregnant patients with CKD stage I-IIIa from Taipei Medical University Research Database between 1 January 2012 and 31 August 2017 were recruited. These patients were divided into Early CKD Care Programme participants (case) and non-participants (control). The models were matched by age, sex, estimated glomerular filtration rate and CKD stage with 1:2 propensity score to reduce bias between two groups.

Outcome measures: The risks of CKD stage I-IIIa progression to IIIb between Early CKD Care Programme participants and non-participants.

Results: Compared with the control group, the case group demonstrated more comorbidities and higher proportions of hypertension, diabetes mellitus, gout, dyslipidaemia, heart disease and cerebrovascular disease, but had lower risk of progression to CKD stage IIIb before and (HR 0.72; 95% CI 0.61 to 0.85) and after (adjusted HR (aHR) 0.67; 95% CI 0.55 to 0.81) adjustments. Moreover, Kaplan-Meier analysis revealed the cumulative incidence of CKD stage IIIb was significantly lower in the case group than in the control group. Finally, the programme was an independent protective factor against progression to stage IIIb, especially in patients with CKD stage IIIa before (HR 0.72; 95% CI 0.61 to 0.85) and after (aHR 0.67; 95% CI 0.55 to 0.81) adjustments.

Conclusions: The Early CKD Care Programme is an independent protective factor against progression of early CKD.

Keywords: chronic renal failure; health policy; nephrology.