Evaluation of multidisciplinary care pathways on kidney function in patients with advanced chronic kidney disease: multicenter study.

BACKGROUND

Chronic Kidney Disease (CKD) is a significant public health issue due to its increasing prevalence and associated high morbidity and mortality rates.

METHODS

This study evaluates the impact of multidisciplinary care pathways consisting of medical, dietetic and coordinating nurse follow ups, on kidney function, survival, clinical biological parameters and quality of life in patients with advanced CKD (stages 4 and 5). A retrospective analysis of clinical and biological parameters was conducted, alongside a prospective assessment of quality of life using the EQ-5D-5L tool.

RESULTS

Among 359 patients, (141 with complete multidisciplinary follow-up, 100 with partial follow-up, and 118 with medical-only follow-up), mortality rates were significantly higher in the medical-only group (26%) compared to those who received complete (8%) and partial multidisciplinary follow-up (16%) (p < 0.001). No significant differences were observed in kidney function progression or dialysis initiation. Autonomy (Pearson's chi-square: 15.32, p = 0.05) and overall quality of life in the medical-only group were significantly lower (Cumulative Adjusted EQ-5D-5L- complete follow-up: 0.83, partial follow-up: 0.82 and medical only: 0.70-p = 0.037), as was the quality-of-life visual self-assessment (EQ VAS Scores- complete follow-up: 65, partial follow-up: 63 and medical only: 53 p = 0.024). The differences are important and clinically relevant.

CONCLUSIONS

The current study suggests that participation in a Multidisciplinary Care Pathway does not significantly change kidney function progression or dialysis initiation but may be associated with decreased mortality and better quality of life parameters.