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. 2022 Apr;54(4):949-957.
doi: 10.1007/s11255-021-02963-y. Epub 2021 Jul 31.

Ten-year experience of an outpatient clinic for CKD-5 patients with multidisciplinary team and educational support

Vincenzo Terlizzi  1 , Massimo Sandrini  1 , Valerio Vizzardi  2 , Mattia Tonoli  3 , Annalisa Facchini  3 , Luigi Manili  1 , Letizia Zeni  1 , Giovanni Cancarini  1   3
Affiliations

Ten-year experience of an outpatient clinic for CKD-5 patients with multidisciplinary team and educational support

Vincenzo Terlizzi et al. Int Urol Nephrol. 2022 Apr.

Abstract

Purpose: To analyze the results of an outpatient clinic with a multidisciplinary team and educational support for patients with late-stage CKD (lsCKD), to check its possible effect on their outcomes.

Methods: Longitudinal cohort study on patients followed up in the MaReA (Malattia Renale Avanzata = CKD5) outpatient clinic at ASST Spedali Civili of Brescia from 2005 to 2015 for at least six months. Trajectory of renal function over time has been evaluated only in those patients with at least four estimations of eGFR before referring to MaReA.

Results: Seven hundred and six patients were enrolled, their mean age was 72 ± 14 years, 59% were males. At the end of the study, 147 (21%) were still on MaReA, 240 (34%) on dialysis, 92 (13%) on very low-protein diet (VLPDs), 13 (2%) on pre-hemodialysis clinic, 23 (3%) improved renal function, 10 (1%) transplanted, 62 (9%) transferred/lost to follow-up, and 119 (17%) died. Optimal dialysis start (defined as start with definitive dialysis access, as an out-patient and without lsCKD complications) occurred in 180/240 (75%) patients. The results showed a slower eGFR decrease during MaReA follow-up compared to previous renal follow-up: - 2.0 vs. - 4.0 mL/min/1.73 m2 BSA/year (p < 0.05), corresponding to a median delay of 17.7 months in dialysis start in reference to our policy in starting dialysis. The patient cumulative survival was 75% after 24 months and 25% after 70.

Limitations: (1) lack of a control group, (2) one-center-study, (3) about all patients were Caucasians.

Conclusion: The follow-up of lsCKD patients on MaReA is associated with an optimal and delayed initiation of dialysis.

Keywords: Delaying dialysis; End-stage renal disease; GFR trajectory; Optimal start of dialysis; Patient survival; Start of dialysis.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Fig. 1
Fig. 1
Flow chart of patient selection and outcome
Fig. 2
Fig. 2
Changes in eGFR with CKD-EPI and MDRD formula before and during MaReA. Seven outliers in each panel have not been shown to increase readability of the figure
Fig. 3
Fig. 3
Median eGFR decrease according to CKD-EPI equation. Continuous line: eGFR decrease in pre-MaReA period; dotted line: expected trajectory of eGFR after starting MaReA, according to the previous decrease rate; dashed line: observed eGFR decrease during MaReA period. See Table 4 for further explanation
See this image and copyright information in PMC

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