Effectiveness and acceptability of a multidisciplinary approach in improving the care of patients with advanced chronic kidney disease: a pilot study

• Published in: International urology and nephrology 2022-04, Vol.54 (4), p.917-926
• Main Authors: Kwek, Jia Liang, Griva, Konstadina, Kaur, Navreen, Chong, Kay Yuan, Chua, Zi Yang, Sim, Gim Hong Andy, Ng, Li Choo, Yong, Pay Wen, Tung, Yu-Tzu, Lim, Lydia Wei Wei, Teo, Su Hooi, Choo, Jason Chon Jun, Foo, Marjorie Wai Yin, Jafar, Tazeen Hasan
• Format: Article
• Language: English
• Subjects: Aged; Epidermal growth factor receptors; Glomerular Filtration Rate; Humans; Kidney diseases; Medicine; Medicine & Public Health; Nephrology; Nephrology - Original Paper; Patients; Pilot Projects; Quality of Life; Renal failure; Renal Insufficiency, Chronic - complications; Renal Insufficiency, Chronic - therapy; Urology
• ISSN: 0301-1623; 1573-2584
• DOI: 10.1007/s11255-021-02946-z

Objective This study aimed at determining the feasibility of conducting a large-scale pragmatic effectiveness study on the implementation of multidisciplinary care (MDC) program for patients with advanced chronic kidney disease (CKD). Methods This is a single-arm pre-post intervention design pilot study over 12 months. Participants with an estimated glomerular filtration rate (eGFR) between 11 and 20 ml/min/1.73m 2 were screened and recruited at the initial MDC clinic visit and followed for 12 months. Clinical parameters, KDQOL ™ -36, questionnaires, and interviews were collected, administered, and analysed for enrolment and completion rates, baseline characteristics, implementation fidelity, adherence to CKD interventions, eGFR decline, CKD complications, health-related quality of life, and participants’ acceptability of the program. Results The study enrolment and completion rates were 43.1% (50/116 screened) and 66.0% (33/50 recruited) respectively. The participants had a mean age of 68.5 years (SD9.0) and a mean eGFR of 15.4 ml/min/1.73m 2 (3.2). After 12 months of MDC program, there was increased adherence to CKD interventions (difference  − 0.6(1.0), 95%CI  − 1.1,  − 0.1, p  = 0.02). There was good participants’ acceptability of the program with participants being more satisfied with the waiting time and having a better understanding of kidney failure after attending the program. No difference in the eGFR decline noted (difference 0.0 ml/min/1.73m 2 (5.3), 95%CI  − 1.9, 1.9, p  = 1.00). Conclusion Our pilot data suggest increased adherence to CKD interventions and good acceptability to MDC program, albeit no difference in eGFR decline probably because of the small sample size. However, reasons for overall low enrolment and completion rates need to be explored and addressed while designing a future large-scale randomised controlled trial.