Kidney Week

Abstract: PO0991

Effect of Multidisciplinary Care Models on Glomerular Filtration Rate for Patients with Diabetic Kidney Disease: Systematic Review and Meta-Analysis

Session Information

• Diabetic Kidney Disease: Clinical - 1
  October 22, 2020 | Location: On-Demand
  Abstract Time: 10:00 AM - 12:00 PM

Category: Diabetic Kidney Disease

• 602 Diabetic Kidney Disease: Clinical

Authors

• Dib, Andrea, Universidad Panamericana, Ciudad de Mexico, Ciudad de México, Mexico

Andrea Dib,

• Perez-Ortiz, Andric C., Universidad Panamericana, Ciudad de Mexico, Ciudad de México, Mexico

Andric C. Perez-Ortiz,

• Contreras Estrada, Daniela, Universidad Panamericana, Ciudad de Mexico, Ciudad de México, Mexico

Daniela Contreras Estrada,

• Cantillo, Laura, Universidad Panamericana, Ciudad de Mexico, Ciudad de México, Mexico

Laura Cantillo,

• Anasagasti, Lorea, Universidad Panamericana, Ciudad de Mexico, Ciudad de México, Mexico

Lorea Anasagasti,

• Antonio Aguirre, Bani, Universidad Panamericana, Ciudad de Mexico, Ciudad de México, Mexico

Bani Antonio Aguirre,

• Gutiérrez, Diego Soní, Universidad Panamericana, Ciudad de Mexico, Ciudad de México, Mexico

Diego Soní Gutiérrez,

• Obrador, Gregorio T., Universidad Panamericana, Ciudad de Mexico, Ciudad de México, Mexico

Gregorio T. Obrador,

Background

Since 2015, the Kidney Disease Improving Global Outcomes guidelines advocate for comprehensive conservative care for diabetic nephropathy (DN) patients. Multidisciplinary care (MCD) models are such strategies that offer integrated care to delay renal disease progression, reduce micro- and macrovascular complications of diabetes, increase the quality of life, and reduce associated costs. Prior reviews have assessed the effect of MCDs in all-cause mortality, hospitalization rate, and need for temporal or permanent renal replacement therapy. However, to date, there are no reviews on their impact on glomerular filtration rate (GFR).

Methods

We conducted a systematic search of observational and randomized trials on DN GFR assessments. We searched Ovid and PubMed databases. Following the STROBE and CONSORT recommendations, we assessed the quality of evidence and any selection/information bias from our resulted pool of evidence. Our primary outcome was GFR quantifications between MCD vs. non-MCD DN treated patients. We performed a meta-analysis of these measurements using random and fixed effects models and examined inter-study heterogeneity with meta-regression models.

Results

There were 93 records from our systematic search. We screened titles and abstracts and retrieved eight records (9,892 participants) for qualitative and quantitative assessments. By subgroup analyses, MCD had a statistically significant effect on GFR among younger patients (<65 years, x0.53-fold increase in GFR vs. non-MCD) with long-term follow-up (>2 years, x0.57-fold increase in GFR vs. non-MCD) (Table).

Conclusion

Based on eight records with significant sample size, MCDs might have a positive effect on GFR if implemented earlier (preferably before age 65). However, this benefit might not be seen immediately, rather in the long-term. We suggest implementing these approaches as standard of care for DN.