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Kidney Week

Abstract: PO0580

Interdisciplinary Care Improves Patient Preparedness for ESRD in a High-Risk Patient Population with CKD

Session Information

Category: CKD (Non-Dialysis)

  • 2102 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

  • Prudhvi, Kalyan, Albert Einstein College of Medicine, Bronx, New York, United States
  • Sedaliu, Kaltrina, Albert Einstein College of Medicine, Bronx, New York, United States
  • Estrella, Michelle M., San Francisco VA Medical Center, San Francisco, California, United States
  • Boulware, L. Ebony, Duke University School of Medicine, Durham, North Carolina, United States
  • Melamed, Michal L., Albert Einstein College of Medicine, Bronx, New York, United States
  • Johns, Tanya S., Albert Einstein College of Medicine, Bronx, New York, United States
Background

The Kidney Care Choice initiative has made improving the quality of care for patients with late-stage CKD a national priority. Interdisciplinary care (IDC), including nurse practitioner (NP) driven care coordination, is an intervention that may improve health outcomes in patients with CKD. Few studies have evaluated this model of healthcare delivery in racial-ethnic minorities.

Methods

We compared incident ESRD patients who received NP care coordination as part of our IDC clinic (n=84) to a contemporaneous cohort of incident ESRD patients (n=245) who received usual nephrology care alone at Montefiore Medical Center from 10/1/2013—10/31/2017. Clinical data were extracted using Clinical Looking Glass®, and chart reviews were done for validation. Patients included in our study had established care for CKD stage 4/5 and had at least one nephrology clinic visit within 3 months preceding their progression to ESRD. All patients were eligible for IDC, but receipt of IDC was limited by resource availability.

Results

Of the 329 incident ESRD patients included in our study, the mean age was 59.6 years (SD 13.8), 47% were female, and 86% were African American or Hispanic. The baseline characteristics were similar between the groups, except the IDC group had a lower prevalence of hypertension (60% vs 77%). The mean eGFR was 8 ml/min/1.73m2 at dialysis initiation. Fifty percent of patients had an arteriovenous (AV) access prior to developing ESRD. However, compared to the usual care group, patients in IDC group were more likely to have a mature AV access at HD initiation (41% vs 33%); start HD as an outpatient (30% vs 19%); receive a preemptive transplant (4% vs 2%); do peritoneal dialysis (7% vs 4%); and be listed for kidney transplant (44% vs 15%) prior to developing ESRD. Receipt of IDC was associated with a higher odds (OR 3.9 [95% CI 2.0 - 7.8]; P< 0.001) of kidney transplant listing compared to usual care alone after adjusting for sociodemographic and clinical factors. Other outcomes also favored IDC but were not statistically significant.

Conclusion

Interdisciplinary care is associated with better ESRD preparedness compared to usual nephrology care alone in racial-ethnic minorities. Larger multicenter randomized studies are needed to determine the effectiveness of IDC among patients with advanced CKD.
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Funding

  • Other NIH Support