Related Experiment Video
Updated: Jun 22, 2025
5/6 Nephrectomy Using Sharp Bipolectomy Via Midline Laparotomy in Rats
Published on: April 4, 2025
Major adverse kidney events in multidisciplinary chronic kidney disease care compared with usual outpatient care: a
Palita Chittinandana1, Pongsathorn Gojaseni2, Anan Chuasuwan1
1Division of Nephrology, Department of Medicine, Bhumibol Adulyadej Hospital, Royal Thai Air Force, Bangkok, Thailand.
Insights
Multidisciplinary CKD care significantly reduced major adverse kidney events and mortality in patients with stages G3b-4 chronic kidney disease (CKD). This approach, especially for diabetes mellitus patients, improved kidney outcomes compared to usual care.
Area of Science:
- Nephrology
- Public Health
- Clinical Medicine
Background:
- Chronic kidney disease (CKD) is a global health concern requiring effective management strategies.
- Multidisciplinary care is recommended for CKD to slow progression and reduce complications, but its impact on major adverse kidney events remains unclear.
Purpose of the Study:
- To evaluate the effectiveness of multidisciplinary CKD care (MDC) versus usual outpatient care (UOC) on major adverse kidney events in CKD patients.
- To assess the impact of MDC on kidney function decline, mortality, and hospitalization rates.
Main Methods:
- A cohort study included patients with CKD stages G3b-4 from 2014-2020.
- Propensity score matching was used to compare MDC and UOC groups based on key clinical factors.
- The primary outcome was a composite of cardiovascular or renal mortality, 40% eGFR decline, or initiation of kidney replacement therapy.
Main Results:
- After matching, 822 patients (mean age 70.9 years, 64% with diabetes) were analyzed.
- MDC significantly lowered the primary endpoint rate (24.1% vs. 38.9%, HR 0.66) and 40% eGFR decline (21.7% vs. 35.0%, HR 0.67).
- MDC also reduced all-cause mortality (8.5% vs. 19.5%, HR 0.60) and hospitalizations per year (P < 0.001), with enhanced benefits for diabetes patients.
Conclusions:
- Multidisciplinary CKD care demonstrates significant benefits for kidney outcomes in patients with CKD stages G3b-4 compared to usual outpatient care.
- The positive effects of MDC were particularly pronounced in patients with diabetes mellitus.
- These findings support the implementation of multidisciplinary care models for managing advanced CKD.
Background:
Chronic kidney disease (CKD) is a public health problem worldwide. Multidisciplinary care has been recommended in clinical practice to delay disease progression and minimize complications. However, the effectiveness of multidisciplinary care on major adverse kidney events in CKD patients is still inconclusive.
Methods:
We conducted a cohort study in patients with CKD stages G3b to 4 who were followed up at Bhumibol Adulyadej Hospital from 2014 to 2020. Propensity score matching by age, sex, CKD staging, Diabetes Mellitus (DM), blood pressure and rate of estimated Glomerular Filtration Rate (eGFR) decline before inclusion between patients in multidisciplinary CKD care (MDC) and usual outpatient care (UOC) was performed. The primary outcome was a composite of cardiovascular or renal mortality, 40% eGFR decline and initiation of long-term kidney replacement therapy.
Results:
After 1:1 propensity score matching, 822 patients were included. Mean age was 70.9 years, 64% had diabetes. During the mean follow-up of 3.3 years, rate of reaching the primary endpoint was lower in the multidisciplinary CKD care group than in the usual outpatient care group (24.1% vs. 38.9%; hazard ratio [HR], 0.66; 95% confidence interval [CI], 0.52-0.86; P = 0.002). The multidisciplinary CKD care group benefited more than the usual outpatient care group with regard to 40% eGFR decline (21.7% vs. 35.0%; HR, 0.67; 95%CI 0.52-0.88; P = 0.004), all-cause mortality (8.5% vs. 19.5%; HR, 0.60; 95%CI 0.40-0.90; P = 0.014), non-cardiovascular death (6.1% vs. 15.1%; HR, 0.56; 95%CI 0.35-0.90; P = 0.015) and hospitalizations per year (1.0 ± 1.5 vs. 1.6 ± 2.0; P < 0.001). According to subgroup analysis, diabetes mellitus patients benefited the most from multidisciplinary CKD care.
Conclusions:
In a tertiary care hospital, multidisciplinary CKD care showed benefits over usual outpatient care on kidney outcomes in patients with CKD stages G3b and 4. The benefit was enhanced in DM patients.
Related Concept Videos
01:11Renal Failure: Dose Adjustments
Reduced renal clearance and elimination rate are common outcomes of renal impairment. These alterations lead to a prolonged elimination half-life and an altered apparent volume of distribution for drugs. As a result, dosage adjustments are typically necessary to maintain optimal drug levels in the body.
However, dosage adjustments...
01:17Factors Affecting Renal Clearance: Renal Impairment
One condition associated with renal failure is uremia. Uremia is characterized by impaired glomerular filtration and fluid accumulation in the body. This condition hinders the renal clearance of drugs, resulting in drug accumulation and potential...
01:27Dialysis
Acute kidney injury develops suddenly and can be caused by pre-renal causes (e.g., hypovolemia, shock), intrinsic renal causes (e.g., acute tubular necrosis), or post-renal causes (e.g., urinary obstruction). In contrast, chronic renal failure progresses gradually over time and is often...
01:22Heart Failure Drugs: Diuretics
01:10Nephrons
01:26Heart Failure Drugs: Inhibitors of Renin-Angiotensin System