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Abstract: SA-PO941

Major Adverse Kidney Events in Multidisciplinary CKD Care Compared With Usual Outpatient Care: A Propensity Score Matched Analysis

Session Information

Category: CKD (Non-Dialysis)

  • 2202 CKD (Non-Dialysis): Clinical‚ Outcomes‚ and Trials

Authors

  • Chittinandana, Palita, Bhumibol Adulyadej Hospital, Bangkok, Bangkok, Thailand
  • Gojaseni, Pongsathorn, Bhumibol Adulyadej Hospital, Bangkok, Bangkok, Thailand
  • Chuasuwan, Anan, Bhumibol Adulyadej Hospital, Bangkok, Bangkok, Thailand
  • Chailimpamontree, Worawon, Bhumibol Adulyadej Hospital, Bangkok, Bangkok, Thailand
  • Chittinandana, Anutra, Bhumibol Adulyadej Hospital, Bangkok, Bangkok, Thailand
Background

Chronic kidney disease (CKD) causes a public health problem worldwide. Multidisciplinary CKD care (MDC) has been recommended in clinical practice guideline to delay disease progression and minimize complications. However, effectiveness of MDC on major adverse kidney events (MAKE) in CKD patients is still inconclusive.

Methods

We conducted a cohort study in patients with CKD stage G3b and 4 who were followed up at Bhumibol Adulyadej Hospital since 2014 to 2020. Propensity score matching by age, sex, CKD staging, diabetes, blood pressure and rate of estimated glomerular filtration rate (eGFR) decline before inclusion between patients in MDC and usual outpatient care (UOC) was done. The primary outcome was MAKE, a composite of cardiovascular or renal mortality, 40% eGFR decline and initiation of long-term kidney replacement therapy.

Results

After 1:1 propensity score matching, 822 patients were included. The mean age was 70.9 years, 64% have diabetes. During the mean follow up of 3.3 years, rate of the primary endpoint was lower in MDC group than UOC group (24.1% vs. 38.9%; hazard ratio [HR], 0.66; 95% confidence interval [CI], 0.52 to 0.86; P=0.002). The results showed benefit of MDC over UOC in 40% eGFR declined (21.7% vs. 35.0%; HR, 0.67; 95%CI 0.52 to 0.88; P=0.004), all-cause mortality (8.5% vs. 19.5%; HR, 0.60; 95%CI 0.40 to 0.90; P=0.014), non-cardiovascular death (6.1% vs. 15.1%; HR, 0.56; 95%CI 0.35 to 0.90; P=0.015) and hospitalization per year (1.0 ± 1.5 vs. 1.6 ± 2.0; P<0.005). According to subgroup analysis, diabetic patients benefit the most from MDC.

Conclusion

In a tertiary care hospital, MDC showed benefits over UOC on kidney outcomes in patients with CKD stage G3b and 4. The benefit will be enhanced in diabetes group.

Figure 1. Forest plot comparing primary and secondary outcome between MDC and UOC

Funding

  • Government Support – Non-U.S.