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. 2022 Oct 14;17(10):e0266617.
doi: 10.1371/journal.pone.0266617. eCollection 2022.

Adherence to multidisciplinary care in a prospective chronic kidney disease cohort is associated with better outcomes

Pablo Rios  1 , Laura Sola  1 , Alejandro Ferreiro  1   2 , Ricardo Silvariño  1   2 , Verónica Lamadrid  1 , Laura Ceretta  1 , Liliana Gadola  1   2 ; all nephrologists who report to Programa de Salud Renal Uruguay Registry
Affiliations

Adherence to multidisciplinary care in a prospective chronic kidney disease cohort is associated with better outcomes

Pablo Rios et al. PLoS One. .

Abstract

Introduction: The Renal Healthcare Program Uruguay (NRHP-UY) is a national, multidisciplinary program that provides care to chronic kidney disease (CKD) patients. In this study, we report the global results of CKD patient outcomes and a comparison between those treated at the NRHP-UY Units, with those patients who were initially included in the program but did not adhere to follow up.

Methods: A cohort of not-on dialysis CKD patients included prospectively in the NRHP-UY between October 1st 2004 and September 30th 2017 was followed-up until September 30th 2019. Two groups were compared: a) Nephrocare Group: Patients who had at least one clinic visit during the first year on NRHP-UY (n = 11174) and b) Non-adherent Group: Patients who were informed and accepted to be included but had no subsequent data registered after admission (n = 3485). The study was approved by the Ethics Committee and all patients signed an informed consent. Outcomes were studied with Logistic and Cox´s regression analysis, Fine and Gray competitive risk and propensity-score matching tests.

Results: 14659 patients were analyzed, median age 70 (60-77) years, 56.9% male. The Nephrocare Group showed improved achievement of therapeutic goals, ESKD was more frequent (HR 2.081, CI 95%1.722-2.514) as planned kidney replacement therapy (KRT) start (OR 2.494, CI95% 1.591-3.910), but mortality and the combined event (death and ESKD) were less frequent (HR 0.671, CI95% 0.628-0.717 and 0.777, CI95% 0.731-0.827) (p = 0.000) compared to the Non-adherent group. Results were similar in the propensity-matched group: ESKD (HR 2.041, CI95% 1.643-2.534); planned kidney replacement therapy (KRT) start (OR 2.191, CI95% 1.322-3.631) death (HR 0.692, CI95% 0.637-0.753); combined event (HR 0.801, CI95% 0.742-0.865) (p = 0.000).

Conclusion: Multidisciplinary care within the NRHP-UY is associated with timely initiation of KRT and lower mortality in single outcomes, combined analysis, and propensity-matched analysis.

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Conflict of interest statement

The authors have declared that no competing interests exist

Figures

Fig 1
Fig 1. Algorithm of selection criteria.
Total population in the National Renal HealthCare Program Uruguay (NRHP-UY), the studied groups distribution and the evolution with follow-up until September 30th 2019.
Fig 2
Fig 2. Survival curves.
Survival curves (Kaplan-Meier) to End stage kidney disease (ESKD), death or both (combined event). A. Global population. B. Matched population.
See this image and copyright information in PMC

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