A nurse-coordinated model of care versus usual care for stage 3/4 chronic kidney disease in the community: A randomized controlled trial.

• Author(s) / Creator(s)

  • Soltys, G.
  • Ayers, D.
  • Molzahn, A.
  • Goeree, R.
  • Rigatto, C.
  • Singer, J.
  • Parfrey, P. S.
  • Soroka, S.
  • Levin, A.
  • Barrett, B. J.
  • Garg, A. X.

• 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

  2011

• Subjects / Keywords

  • Kidney diseases
  • Preventative health services
  • Risk assessement
  • Chronic illness

• Type of Item

  Article (Published)

• DOI

  https://doi.org/10.7939/R35504

• License

  © 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.