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Multidisciplinary CKD care enhances outcomes at dialysis initiation
Judith Dixon1, Patricia Borden, Thomas M Kaneko
1Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA. judith.c.dixon@hitchcock.org
Summary
A multidisciplinary care model for chronic kidney disease (CKD) patients initiating dialysis improved fistula use and anemia management. This approach reduced hospital admissions and costs compared to traditional care.
Area of Science:
- Nephrology
- Public Health
- Healthcare Management
Background:
- Chronic kidney disease (CKD) management requires coordinated care.
- Traditional nephrology care models may not fully address patient needs during dialysis transition.
- A multidisciplinary approach integrating care managers and nephrologists was implemented at Dartmouth-Hitchcock Medical Center in 2003.
Purpose of the Study:
- To compare the outcomes of CKD patients initiating hemodialysis or peritoneal dialysis under a multidisciplinary care model versus traditional nephrology care.
- To evaluate the impact of a multidisciplinary clinic on clinical interventions and patient outcomes.
- To assess the effect on hospital admissions, length of stay, and healthcare costs.
Main Methods:
- A comparative study design involving two groups of patients initiating dialysis.
- Group 1: Received CKD care via a multidisciplinary model (n=89).
- Group 2: Received traditional nephrology care (n=82).
- Outcomes measured included fistula placement and use, hemoglobin levels, hospital admissions, days hospitalized, and 90-day charges.
Main Results:
- The multidisciplinary group showed significantly higher rates of fistula placement (60.7% vs. 21%) and fistula use for dialysis initiation (40.4% vs. 12.3%).
- Patients in the multidisciplinary clinic had better anemia management, with higher pre-dialysis hemoglobin levels (10.9 g/dL vs. 10.0 g/dL).
- Multidisciplinary care was associated with a 42% reduction in hospital admissions for dialysis initiation, fewer hospital days, fewer admissions, and reduced 90-day costs.
Conclusions:
- The multidisciplinary clinic model effectively improves the care of CKD patients transitioning to dialysis.
- This integrated care approach leads to better clinical outcomes, including improved vascular access and anemia control.
- Multidisciplinary care significantly reduces hospitalizations and associated healthcare costs for patients initiating dialysis.
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