The impact of self-management support on the progression of chronic kidney disease--a prospective randomized...

Chronic kidney disease (CKD) is a public health problem worldwide. Multidisciplinary intervention helps improve outcomes for CKD patients. We conducted an open-label, randomized controlled trial to examine the impact of self-management support (SMS) in the outcome of late-stage CKD patients.

Incidental CKD (Stages III-V) patients were randomized into self-management support (SMS) and non-SMS groups and followed up for 12 months. SMS comprised health information, patient education, telephone-based support and the aid of a support group. The primary end points were absolute estimated glomerular filtration rate (eGFR) alteration and number of hospitalization events. The secondary end points were an eGFR decrease of up to 50%, end-stage renal disease (ESRD) demanding renal replacement therapy (RRT), all-cause mortality or a composite secondary end point.

The study included 54 patients; 27 patients were randomized into an SMS group and the same number into a non-SMS group. The absolute eGFR at the end of the study was significantly higher in SMS patients than in the non-SMS group (29.11 ± 20.61 versus 15.72 ± 10.67 mL/min; P < 0.05). There were fewer hospitalization events for SMS patients than for non-SMS patients [5 (18.50%) versus 12 (44.47%); P < 0.05]. One patient (3.7%) in the SMS group and nine (33.3%) in the non-SMS group had an eGFR reduction of >50% (P < 0.05). However, survival analysis of the composite secondary end points of ESRD that required RRT and all-cause mortality revealed no differences between the two groups.

Our randomized study suggests that a standardized SMS program may play a significant role in reducing CKD progression and morbidity of late-stage CKD patients.