Download the full-sized Document
Permanent link (DOI): https://doi.org/10.7939/R35504
This file is in the following communities:
|Nursing, Faculty of|
This file is in the following collections:
A nurse-coordinated model of care versus usual care for stage 3/4 chronic kidney disease in the community: A randomized controlled trial. Open Access
- Author or creator
Barrett, B. J.
Garg, A. X.
Parfrey, P. S.
- Additional contributors
preventative health services
- Type of item
- Journal Article (Published)
Background and objectives: It is unclear how to optimally care for chronic kidney disease (CKD). This study compares a new co-ordinated model to usual care for CKD. Design, setting, participants and measurements: A randomized trial in nephrology clinics and the community included 474 patients with median eGFR 42 mls/min/1.73m2 identified by laboratory-based case finding, compared care co-ordinated by a general practitioner (controls), to care by a nurse co-ordinated team including a nephrologist (intervention) for a median (IQR) of 742 (614-854) days. 32% were diabetic, 60% had cardiovascular disease, and proteinuria was minimal. Guided by protocols, the intervention team targeted risk factors for adverse kidney and cardiovascular outcomes. Serial eGFR and clinical events were tracked. Results: Average decline in eGFR over 20 months was -1.9 mls/min/1.73m2 (95% CI -1.2 to -2.6). eGFR declined by ≥ 4 mls/min/1.73m2 within 20 months in 28 (17%) intervention cases versus 23 (13.9%) controls (p=0.43). Control of blood pressure, LDL, and diabetes were comparable across groups. In the intervention group there was a trend to greater use of renin-angiotensin blockers (p=0.06) and more use of statins in those with initial LDL>2.5 mmol/L (p=0.0003). Treatment was rarely required for anemia, acidosis or disordered mineral metabolism. Clinical events occurred in 5.2% per year. Conclusions: Patients with stage 3-4 CKD identified through community laboratories largely had non-progressive kidney disease, but had cardiovascular risk. Over a median of 24 months the nurse-co-ordinated team did not affect rate of GFR decline or control of most risk factors compared to usual care.
- Date created
- License information
- © 2011 American Society of Nephrology. This version of this article is open access and can be downloaded and shared. The original author(s) and source must be cited.
- Citation for previous publication
Barrett, B. J., Garg, A. X., Goeree, R., Levin, A., Molzahn, A., Rigatto, C., et al. (2011). A nurse-coordinated model of care versus usual care for stage 3/4 chronic kidney disease in the community: A randomized controlled trial. Clinical Journal of the American Society of Nephrology, 6(6), 1241-1247.
- Link to related item
- Date Uploaded
- Date Modified
- Audit Status
- Audits have not yet been run on this file.
File format: msword (Microsoft Word)
Mime type: application/msword
File size: 163840
Last modified: 2015:10:12 11:31:09-06:00
Original checksum: 0b21c5bf290740ac0dd993d712bfe36d
File title: Testing a model of care for chronic kidney disease: the Can-Prevent clinical trial
File author: Brendan Barrett
Page count: 31
File language: U.S. English
Word count: 5624
Character count: 32061