Impact of superimposed nephrological care to guidelines-directed management by primary care physicians of patients with chronic kidney disease: a randomized controlled trial

Abstract Background: Optimal clinical care of patients with chronic kidney disease (CKD) requires collaboration between primary care physicians (PCP) and nephrologists. We undertook a randomised trial to determine the impact of superimposed nephrologist care compared to guidelines-directed management by PCPs in CKD patients after hospital discharge. Methods: Stage 3b-4 CKD patients were enrolled during a hospitalization and randomised in two arms: Co-management by PCPs and nephrologists (interventional arm) versus management by PCPs with written instructions and consultations by nephrologists on demand (standard care). Our primary outcome was death or rehospitalisation within the 2 years post-randomisation. Secondary outcomes were: urgent renal replacement therapy (RRT), decline of renal function and decrease of quality of life at 2 years. Results: From November 2009 to the end of June 2013, we randomised 242 patients. Mean follow-up was 51 + 20 months. Survival without rehospitalisation, GFR decline and elective dialysis initiation did not differ between the two arms. Quality of life was also similar in both groups . Compared to randomised patients, those who either declined to participate in the study or were previously known by nephrologists had a worse survival. Conclusion: These results do not demonstrate a benefit of a regular renal care compared to guided PCPs care in terms of survival or dialysis initiation in CKD patients. Increased awareness of renal disease management among PCPs may be as effective as a co-management by PCPs and nephrologists in order to improve the prognosis of moderate-to-severe CKD.

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Impact of superimposed nephrological care to guidelines-directed management by primary care physicians of patients with stable chronic kidney disease: a randomized controlled trial

10.21203/rs.2.16508/v4 ◽

2020 ◽

Author(s):

Patrick Saudan ◽

Belen Ponte ◽

Nicola Marangon ◽

Chantal Martinez ◽

Lena Berchtold ◽

...

Keyword(s):

Quality Of Life ◽

Primary Care ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Primary Care Physicians ◽

Clinical Care ◽

Randomised Trial ◽

Dialysis Initiation ◽

The Impact

Abstract Background: Optimal clinical care of patients with chronic kidney disease (CKD) requires collaboration between primary care physicians (PCP) and nephrologists. We undertook a randomised trial to determine the impact of superimposed nephrologist care compared to guidelines-directed management by PCPs in CKD patients after hospital discharge. Methods: Stage 3b-4 CKD patients were enrolled during a hospitalization and randomised in two arms: Co-management by PCPs and nephrologists (interventional arm) versus management by PCPs with written instructions and consultations by nephrologists on demand (standard care). Our primary outcome was death or rehospitalisation within the 2 years post-randomisation. Secondary outcomes were: urgent renal replacement therapy (RRT), decline of renal function and decrease of quality of life at 2 years. Results: From November 2009 to the end of June 2013, we randomised 242 patients. Mean follow-up was 51 + 20 months. Survival without rehospitalisation, GFR decline and elective dialysis initiation did not differ between the two arms. Quality of life was also similar in both groups . Compared to randomised patients, those who either declined to participate in the study or were previously known by nephrologists had a worse survival. Conclusion: These results do not demonstrate a benefit of a regular renal care compared to guided PCPs care in terms of survival or dialysis initiation in CKD patients. Increased awareness of renal disease management among PCPs may be as effective as a co-management by PCPs and nephrologists in order to improve the prognosis of moderate-to-severe CKD.

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Impact of superimposed nephrological care to guidelines-directed management by primary care physicians of patients with stable chronic kidney disease: a randomized controlled trial

10.21203/rs.2.16508/v3 ◽

2020 ◽

Author(s):

Patrick Saudan ◽

Belen Ponte ◽

Nicola Marangon ◽

Chantal Martinez ◽

Lena Berchtold ◽

...

Keyword(s):

Quality Of Life ◽

Primary Care ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Primary Care Physicians ◽

Clinical Care ◽

Randomised Trial ◽

Dialysis Initiation ◽

The Impact

Abstract Background: Optimal clinical care of patients with chronic kidney disease (CKD) requires collaboration between primary care physicians (PCP) and nephrologists. We undertook a randomised trial to determine the impact of superimposed nephrologist care compared to guidelines-directed management by PCPs in CKD patients after hospital discharge. Methods: Stage 3b-4 CKD patients were enrolled during a hospitalization and randomised in two arms: Co-management by PCPs and nephrologists (interventional arm) versus management by PCPs with written instructions and consultations by nephrologists on demand (standard care). Our primary outcome was death or rehospitalisation within the 2 years post-randomisation. Secondary outcomes were: urgent renal replacement therapy (RRT), decline of renal function and decrease of quality of life at 2 years. Results: From November 2009 to the end of June 2013, we randomised 242 patients. Mean follow-up was 51 + 20 months. Survival without rehospitalisation, GFR decline and elective dialysis initiation did not differ between the two arms. Quality of life was also similar in both groups . Compared to randomised patients, those who either declined to participate in the study or were previously known by nephrologists had a worse survival. Conclusion: These results do not demonstrate a benefit of a regular renal care compared to guided PCPs care in terms of survival or dialysis initiation in CKD patients. Increased awareness of renal disease management among PCPs may be as effective as a co-management by PCPs and nephrologists in order to improve the prognosis of moderate-to-severe CKD.

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The impact of axial spondyloarthritis on quality of life (QoL): a comparison with the impact of moderate to end-stage chronic kidney disease on QoL

Quality of Life Research ◽

10.1007/s11136-018-1900-x ◽

2018 ◽

Vol 27 (9) ◽

pp. 2321-2327 ◽

Cited By ~ 5

Author(s):

Yu Heng Kwan ◽

Warren Fong ◽

Priscilla How ◽

Hwee-Lin Wee ◽

Ying Ying Leung ◽

...

Keyword(s):

Quality Of Life ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Axial Spondyloarthritis ◽

End Stage ◽

The Impact

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The impact of comorbid chronic kidney disease and diabetes on health-related quality-of-life: a 12-year community cohort study

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa031 ◽

2020 ◽

Cited By ~ 2

Author(s):

Melanie L R Wyld ◽

Rachael L Morton ◽

Leyla Aouad ◽

Dianna Magliano ◽

Kevan R Polkinghorne ◽

...

Keyword(s):

Quality Of Life ◽

Chronic Kidney Disease ◽

Cohort Study ◽

Kidney Disease ◽

Short Form ◽

Mixed Effect ◽

Linear Mixed Effect ◽

Prospective Longitudinal ◽

The Impact

Abstract Background Quality-of-life is an essential outcome for clinical care. Both chronic kidney disease (CKD) and diabetes have been associated with poorer quality-of-life. The combined impact of having both diseases is less well understood. As diabetes is the most common cause of CKD, it is imperative that we deepen our understanding of their joint impact. Methods This was a prospective, longitudinal cohort study of community-based Australians aged ≥25 years who participated in the Australian Diabetes, Obesity and Lifestyle study. Quality-of-life was measured by physical component summary (PCS) and mental component summary sub-scores of the Short Form (36) Health Survey. Univariate and multivariate linear mixed effect regressions were performed. Results Of the 11 081 participants with quality-of-life measurements at baseline, 1112 had CKD, 1001 had diabetes and of these 271 had both. Of the 1112 with CKD 421 had Stage 1, 314 had Stage 2, 346 had Stage 3 and 31 had Stages 4/5. Adjusted linear mixed effect models showed baseline PCS was lower for those with both CKD and diabetes compared with either disease alone (P < 0.001). Longitudinal analysis demonstrated a more rapid decline in PCS in those with both diseases. Conclusions The combination of CKD and diabetes has a powerful adverse impact on quality-of-life, and participants with both diseases had significantly poorer quality-of-life than those with one condition.

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The quality of life of chronic kidney disease patients with hypertension treated with angiotensin system-related agents

International Journal of Research in Pharmaceutical Sciences ◽

10.26452/ijrps.v11i4.3573 ◽

2020 ◽

Vol 11 (4) ◽

pp. 6633-6639

Author(s):

Mohammed Salim KT ◽

Saravanakumar RT ◽

Dilip C ◽

Amrutha KP

Keyword(s):

Quality Of Life ◽

Blood Pressure ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Antihypertensive Drugs ◽

Angiotensin Receptor Blockers ◽

Converting Enzyme Inhibitors ◽

Angiotensin System ◽

The Impact

The chronic kidney disease (CKD) co-exist with hypertension in approximately 80 to 85 per cent of patients. The CKD stages can be defined by glomerular filtration rate (GFR), and the deterioration of kidney function or reduction in GFR has observed in those with uncontrolled blood pressure (BP). We had conducted a prospective study to analyse the impact of the angiotensin system-related agents on the quality of life of CKD patients with hypertension. The SF-36 questionnaire, direct patients interview and medical records were the sources for retrieval of information. We observed that male patients were more prone to CKD than female. Hypertension was the primary (77.8%) aetiology behind the incidence of CKD. The angiotensin-converting enzyme inhibitors (ACEI) was responsible for very low (58%) and low (44%) health disabilities to the patients. In contrast, the angiotensin receptor blockers (ARB) even though it has a limited adverse effect, the patients complained of medium (9%) and high disabilities than the ACEIs. The discontinuation of the antihypertensive drugs by the CKD patients was almost negligible (3.4%). The study concludes that a balanced diet and reasonable blood pressure control is essential to prevent the progression of CKD and to improve the quality of life.

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Educational approaches focusing on the quality of life of people with chronic kidney disease receiving hemodialysis: an integrative review

Fisioterapia em Movimento ◽

10.1590/1980-5918.030.003.ar01 ◽

2017 ◽

Vol 30 (3) ◽

pp. 595-605

Author(s):

Pedro Cezar Beraldo ◽

Simone Tetu Moysés ◽

Renata Iani Werneck ◽

Eduardo Santana de Araujo ◽

Samuel Jorge Moysés

Keyword(s):

Quality Of Life ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Treatment Adherence ◽

Patient Adherence ◽

Complete Agreement ◽

Treatment Objective ◽

Psychosocial Conditions ◽

The Impact

Abstract Introduction: The impact of chronic kidney disease (CKD) on the quality of life of patients receiving hemodialysis is widely studied. Despite the vast amount of literature on the topic, it is still important to investigate the educational approaches related to this population’s quality of life, evolution, and treatment. Objective: To systematically review the literature on educational approaches focusing on people with CKD receiving hemodialysis. Methods: An integrative systematic review of studies published between 2010 and 2015 was conducted using the PubMed, LILACS, PROQUEST, SCIENCEDIRECT, and SciELO databases using the keywords “quality of life and hemodialysis and adults”, with their translation equivalents in Portuguese and Spanish. Results: The studies included in this review investigated biological conditions, treatment adherence, psychosocial conditions, and even spiritual influence. These studies unanimously recognized the validity of educational approaches, be it for treatment adherence, actor´s empowerment, or self-knowledge, as well as the importance of addressing a wider patient view and participatory therapy planning. Conclusion: The quality of life of people with CKD is a widely and differently studied topic, but the number of educational approaches focusing on this group of patients is modest and poorly represented in the existing literature. The few studies that address this topic are in complete agreement about the importance and relevance of educational approaches for people with CKD. We conclude that patient adherence, participation, and empowerment should be considered and encouraged.

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