Examine the optimal multidisciplinary care teams for patients with chronic kidney disease from a nationwide cohort study

Masanori Abe; Tsuguru Hatta; Yoshihiko Imamura; Tsutomu Sakurada; Shinya Kaname

doi:10.23876/j.krcp.23.026

Examine the optimal multidisciplinary care teams for patients with chronic kidney disease from a nationwide cohort study

Kidney Res Clin Pract. 2023 Oct 5. doi: 10.23876/j.krcp.23.026. Online ahead of print.

Authors

Masanori Abe^{1

2}, Tsuguru Hatta^{1

3}, Yoshihiko Imamura^{1

4}, Tsutomu Sakurada^{1

5}, Shinya Kaname^{1

6}

Affiliations

¹ The Committee of the Evaluation and Dissemination for Certified Kidney Disease Educator, Japan Kidney Association.
² Division of Nephrology, Hypertension and Endocrinology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan.
³ Second Department of Medicine, Hatta Medical Clinic, Kyoto, Japan.
⁴ Department of Nephrology, Nissan Tamagawa Hospital, Tokyo, Japan.
⁵ Department of Nephrology and Hypertension, St. Marianna University School of Medicine, Kanagawa, Japan.
⁶ Department of Nephrology and Rheumatology, Kyorin University School of Medicine, Tokyo, Japan.

PMID: 37885176
DOI: 10.23876/j.krcp.23.026

Abstract

Background: Multidisciplinary team-based integrated care (MDC) has been recommended for patients with chronic kidney disease (CKD). However, team-based specific structured care systems are not yet established. Therefore, we investigated the efficacy of MDC system and the optimal number of professionals that make up the team for maintaining kidney function and improving prognosis.

Methods: This nationwide, multicenter, observational study included 2,957 Japanese patients with CKD who received MDC from 2015 to 2019. The patients were divided into four groups according to the number of professionals in the MDC team. Groups A, B, C, and D included nephrologists and one, two, three, and four or more other professionals, respectively. Changes in the annual decline in estimated glomerular filtration rate before and after MDC were evaluated. Cox regression was utilized to estimate the correlation between each group and all-cause mortality and the start of renal replacement therapy (RRT) for 7 years.

Results: The change in eGFR significantly improved between before and at 6, 12, and 24 months after MDC in all groups (all p < 0.0001). Comparing group D to group A (reference), the hazard ratio (HR) for all-cause mortality and the start of the RRT was 0.60 (95% confidence interval, 0.48-0.73; p < 0.0001) after adjustment for multiple confounders. Lower HR in group D was confirmed in both diabetes and nondiabetes subgroups.

Conclusion: An MDC team comprised of five or more professionals might be associated with improvements in mortality and kidney prognosis. Furthermore, MDC might be effective for treating CKD other than diabetes.

Keywords: Certified kidney disease educator; Chronic kidney disease; Estimated glomerular filtration rate; Kidney function; Multidisciplinary care; Renal replacement therapy.