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The Effect of Medical Cooperation in the CKD Patients: 10-Year Multicenter Cohort Study
Yasuhiro Onishi1,2, Haruhito A Uchida1,3, Yohei Maeshima1,4,5
1Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan.
Insights
Medical cooperation significantly reduced all-cause mortality in chronic kidney disease (CKD) patients. However, this collaboration was also associated with faster CKD progression, highlighting a complex impact on patient outcomes.
Area of Science:
- Nephrology
- Public Health
- Internal Medicine
Background:
- Chronic kidney disease (CKD) is a major cause of mortality globally, exacerbated by a worldwide shortage of nephrologists.
- Medical cooperation, involving primary care physicians and specialized nephrology institutions, aims to improve CKD care.
- While multidisciplinary teams show benefits, the impact of a comprehensive medical cooperation system on CKD patient outcomes remains understudied.
Purpose of the Study:
- To evaluate the effect of a medical cooperation system on all-cause mortality and renal prognosis in patients with CKD.
- To assess the influence of integrated care models on key CKD adverse events.
Main Methods:
- A cohort study involving 168 CKD patients from Okayama city clinics and hospitals (December 2009 - September 2016).
- 123 patients were assigned to a medical cooperation group, with outcomes including all-cause mortality and a composite renal endpoint (end-stage renal disease or 50% eGFR decline).
- Fine-Gray subdistribution hazard models were used to analyze competing risks for mortality and renal composite outcomes.
Main Results:
- The medical cooperation group exhibited different baseline characteristics, including higher rates of glomerulonephritis and lower rates of nephrosclerosis compared to the primary care group.
- Over a median follow-up of 5.59 years, all-cause mortality was significantly reduced in the medical cooperation group (sHR 0.297, p=0.021).
- Conversely, medical cooperation was significantly associated with an increased risk of CKD progression (sHR 3.069, p=0.017).
Conclusions:
- Medical cooperation demonstrated a significant benefit in reducing all-cause mortality among CKD patients.
- The study identified a concerning association between medical cooperation and accelerated CKD progression.
- Findings suggest that while medical cooperation may improve survival, its impact on renal function requires careful consideration and further investigation.
Introduction:
While chronic kidney disease (CKD) is one of the most important contributors to mortality from non-communicable diseases, the number of nephrologists is limited worldwide. Medical cooperation is a system of cooperation between primary care physicians and nephrological institutions, consisting of nephrologists and multidisciplinary care teams. Although it has been reported that multidisciplinary care teams contribute to the prevention of worsening renal functions and cardiovascular events, there are few studies on the effect of a medical cooperation system.
Methods:
We aimed to evaluate the effect of medical cooperation on all-cause mortality and renal prognosis in patients with CKD. One hundred and sixty-eight patients who visited the one hundred and sixty-three clinics and seven general hospitals of Okayama city were recruited between December 2009 and September 2016, and one hundred twenty-three patients were classified into a medical cooperation group. The outcome was defined as the incidence of all-cause mortality, or renal composite outcome (end-stage renal disease or 50% eGFR decline). We evaluated the effects on renal composite outcome and pre-ESRD mortality while incorporating the competing risk for the alternate outcome into a Fine-Gray subdistribution hazard model.
Results:
The medical cooperation group had more patients with glomerulonephritis (35.0% vs. 2.2%) and less nephrosclerosis (35.0% vs. 64.5%) than the primary care group. Throughout the follow-up period of 5.59 ± 2.78 years, 23 participants (13.7%) died, 41 participants (24.4%) reached 50% decline in eGFR, and 37 participants (22.0%) developed end-stage renal disease (ESRD). All-cause mortality was significantly reduced by medical cooperation (sHR 0.297, 95% CI 0.105-0.835, p = 0.021). However, there was a significant association between medical cooperation and CKD progression (sHR 3.069, 95% CI 1.225-7.687, p = 0.017).
Conclusion:
We evaluated mortality and ESRD using a CKD cohort with a long-term observation period and concluded that medical cooperation might be expected to influence the quality of medical care in the patients with CKD.
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