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Published on: November 15, 2013
Insights
Early multidisciplinary care for chronic kidney disease (CKD) in a clinical pathway (CP) significantly delayed dialysis initiation. This approach also reduced mortality and hospitalization risk for CKD patients.
Area of Science:
- Nephrology
- Public Health
- Healthcare Management
Context:
- Belgian healthcare authorities introduced a clinical pathway (CP) for chronic kidney disease (CKD) in 2009.
- Significant costs associated with end-stage kidney disease (ESKD) treatment by dialysis prompted this initiative.
- A retrospective cohort study was conducted to evaluate the impact of CP on CKD patients.
Purpose:
- To test the hypothesis that CP enrollment reduces morbidity, mortality, and delays dialysis admission.
- To analyze the association between CP inclusion and time to dialysis initiation.
- To assess the impact of CP on mortality and hospitalization risk post-dialysis.
Summary:
- CKD patients enrolled in a CP (n=25) experienced a significant delay in dialysis initiation compared to controls (n=25).
- CP inclusion was associated with reduced mortality (HR=0.10) and hospitalization risk (HR=0.30) after starting dialysis.
- Survival analyses indicated a protective effect of the multidisciplinary CKD-CP.
Impact:
- Findings suggest that multidisciplinary care within a CKD clinical pathway offers significant benefits.
- The study highlights the potential for CP to improve patient outcomes and manage healthcare costs.
- Larger-scale studies are recommended to validate these promising results in a broader population.
Abstract:
Because of the significant costs related to the treatment of end-stage kidney disease by dialysis, Belgian Health Care Authorities proposed in June 2009 an early multidisciplinary care of the chronic kidney disease (CKD) in a so-called clinical pathway (CP). Working on the hypothesis that inclusion into a CP could result in reduced morbidity and mortality and delayed admission on dialysis, we initiated a retrospective cohort study on dialyzed patients for whom a prior CKD diagnosis was made between June 1, 2009 and August 31, 2013 in the Nephrology Dept of Erasme Hospital. The exposed patient group was defined as enrolled patients into a CP (n = 25), the control patients were free of any CP (n = 25). Survival analyses were performed to search for an association between the inclusion into a CP and the time period needed to reach dialysis, but also to find a possible impact of CP on mortality and risk of hospitalization. The present study showed that CKD-CP significantly delayed the time of dialysis initiation (HR = 0.48 [0.27-0.87]; p = 0.015) but also reduced mortality (HR = 0.10 [0.02-0.53]; p = 0.007) and hospitalization risk (HR = 0.30 [0.11-0.83]; p = 0.020) after starting dialysis. These data suggest the benefit of a multidisciplinary care of CKD patients. However, a larger scale study is necessary to confirm these results.
