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. 2018 Feb;50(2):301-312.
doi: 10.1007/s11255-017-1679-7. Epub 2017 Aug 30.

The effectiveness of multidisciplinary care models for patients with chronic kidney disease: a systematic review and meta-analysis

Yu Shi  1 , Jiachuan Xiong  1 , Yan Chen  1 , Junna Deng  1 , Hongmei Peng  1 , Jinghong Zhao  1 , Jing He  2
Affiliations

The effectiveness of multidisciplinary care models for patients with chronic kidney disease: a systematic review and meta-analysis

Yu Shi et al. Int Urol Nephrol. 2018 Feb.

Abstract

Aim: To assess the efficacy of the multidisciplinary care (MDC) model for patients with chronic kidney disease (CKD).

Background: The MDC model has been used in clinical practice for years, but the effectiveness of the MDC model for patients with CKD remains controversial.

Methods: Embase, PubMed, Medline, the Cochrane Library, and China National Knowledge Infrastructure databases were used to search for relevant articles. Only randomized controlled trials and cohort studies were pooled. Two independent authors assessed all articles and extracted the data. The efficacy was estimated from the odds ratios and corresponding 95% confidence intervals. A random effects model was used according to the heterogeneity.

Results: Twenty-one studies including 10,284 participants were analyzed. Compared with the non-MDC group, MDC was associated with a lower risk of all-cause mortality and lower hospitalization rates for patients with CKD. In addition, MDC also resulted in a slower eGFR decline and reduced temporary catheterization for patients receiving dialysis. However, according to the subgroup analysis, the lower rates of all-cause mortality in the MDC group were observed only in patients in stage 4-5 and when the staff of the MDC consisted of nephrologists, nurse specialists and professionals from other fields. The most prominent effect of reducing the hospitalization rates was also observed in patients with stage 4-5 but not in patients with stage 4-5 CKD.

Conclusions: MDC can lower the all-cause mortality of patients with CKD, reduce temporary catheterization for patients receiving dialysis, decrease the hospitalization rate, and slow the eGFR decline. Moreover, the reduction in all-cause mortality crucially depends on the professionals comprising the MDC staff and the stage of CKD in patients. In addition, the CKD stage influences the hospitalization rates.

Keywords: Care; Chronic kidney disease; Multidisciplinary; Systematic reviews and meta-analysis.

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Conflict of interest statement

Conflict of interest

The authors have no interest conflicts regarding this study.

Availability of data and material

Embase, PubMed, Medline, the Cochrane Library, and China National Knowledge Infrastructure (CNKI) databases were used to identify all relevant published articles for review. These articles are open to the public.

Ethical standard

In accordance with the ethical standards of institutional and international research committee, this article is based on previous published studies; thus, it does not contain any studies with human participants or animals.

Figures

Fig. 1
Fig. 1
Flowchart of meta-analysis
Fig. 2
Fig. 2
All-cause mortality of chronic kidney disease (CKD) patients on multidisciplinary care (MDC) and on non-MDC
Fig. 3
Fig. 3
Subgroup analysis of all-cause mortality of chronic kidney disease (CKD) patients on different MDC components
Fig. 4
Fig. 4
Subgroup analysis of all-cause mortality of chronic kidney disease (CKD) patients on CKD 1–5 and CKD 4–5
Fig. 5
Fig. 5
Subgroup analysis of all-cause mortality of chronic kidney disease (CKD) patients on RCTs and cohort
Fig. 6
Fig. 6
Incidence of temporal catheterization for dialysis in chronic kidney disease (CKD) patients on multidisciplinary care (MDC) and non-MDC
Fig. 7
Fig. 7
Subgroup analysis of risk of hospitalization for chronic kidney disease (CKD) patients on multidisciplinary care (MDC) and non-MDC
Fig. 8
Fig. 8
Risk of eGFR for chronic kidney disease (CKD) patients on multidisciplinary care (MDC) and non-MDC
Fig. 9
Fig. 9
Funnel plot used for exploring the source of publication bias
See this image and copyright information in PMC

Comment in

  • Living Kidney Donation Between African Immigrants.
    Ríos A, Balaguer-Román A, Carrillo J, López-Navas AI, Ayala-García MA, Ramírez P. Ríos A, et al. Prog Transplant. 2023 Dec;33(4):360-362. doi: 10.1177/15269248231212909. Epub 2023 Nov 14. Prog Transplant. 2023. PMID: 37964550 No abstract available.

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