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Eur J Intern Med. 2015 Oct;26(8):640-5. doi: 10.1016/j.ejim.2015.07.002. Epub 2015 Jul 14.

Multidisciplinary care in patients with chronic kidney disease: A systematic review and meta-analysis.

Author information

1
Kidney Institute and Division of Nephrology, China Medical University Hospital, Taichung, Taiwan; College of Medicine, China Medical University, Taichung, Taiwan.
2
College of Medicine, China Medical University, Taichung, Taiwan; Division of Cardiology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.
3
College of Medicine, China Medical University, Taichung, Taiwan; Division of Nephrology, Department of Medicine, Taichung Veterans General Hospital, Taiwan.
4
Kidney Institute and Division of Nephrology, China Medical University Hospital, Taichung, Taiwan; College of Medicine, China Medical University, Taichung, Taiwan. Electronic address: cychou.chou@gmail.com.

Abstract

BACKGROUND:

Multidisciplinary care (MDC) was widely used in multiple chronic illnesses but the effectiveness of MDC in patients with chronic kidney disease (CKD) was inconclusive. The aim of this meta-analysis is to estimate the effectiveness of MDC for CKD.

METHODS:

We searched PubMed, Web of Science, Google Scholar, Cochrane Library, and China Journal Full-text Database for relevant articles published in English or Chinese. Studies investigating MDC and non-MDC in patients with CKD were included. Random effect model was used to compare all-cause mortality, dialysis, risk of temporal catheterization, and hospitalization in the two treatment entities.

RESULTS:

We analyzed 8853 patients of 18 studies in patients with CKD stages 3-5, aged 63±12 years. MDC was associated with lower risk of all-cause mortality with an odds ratio (OR) of 0.52 [95% confidence interval (CI): 0.44-0.88, p=0.01], mainly in cohort studies. MDC was associated with a lower risk of starting dialysis (p=0.02) and lower risk of temporal catheterization for dialysis (p<0.01). MDC was not associated with a higher chance of choosing peritoneal dialysis (p=0.18) or a lower chance of hospitalization for dialysis (p=0.13).

CONCLUSIONS:

Limited evidence from randomized controlled trials is currently available to support the benefit of MDC in patients with CKD. MDC is associated with lower all-cause mortality, lower risk of starting dialysis, and lower risk of temporal catheterization for dialysis in cohort studies. MDC is not associated with a higher chance of choosing peritoneal dialysis or a lower chance of hospitalization for dialysis. More studies are needed to determine the optimal professional that should be included in MDC.

KEYWORDS:

Chronic kidney disease; Dialysis; Meta-analysis; Multidisciplinary care

PMID:
26186813
DOI:
10.1016/j.ejim.2015.07.002
[Indexed for MEDLINE]

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