Nephrologist Follow-Up Care of Patients With Acute Kidney Disease Improves Outcomes: Taiwan Experience.

Autor: Wu VC; Division of Nephrology and Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; NSARF, National Taiwan University Hospital Study Group on Acute Renal Failure (NSARF), Taipei, Taiwan., Chueh JS; Glickman Urological and Kidney Institute, and Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, Ohio, USA., Chen L; Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan., Huang TM; Division of Nephrology and Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; NSARF, National Taiwan University Hospital Study Group on Acute Renal Failure (NSARF), Taipei, Taiwan., Lai TS; Division of Nephrology and Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; NSARF, National Taiwan University Hospital Study Group on Acute Renal Failure (NSARF), Taipei, Taiwan., Wang CY; Department of Internal Medicine, Cardinal Tien Hospital and School of Medicine, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan., Chen YM; Division of Nephrology and Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; NSARF, National Taiwan University Hospital Study Group on Acute Renal Failure (NSARF), Taipei, Taiwan., Chu TS; Division of Nephrology and Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; NSARF, National Taiwan University Hospital Study Group on Acute Renal Failure (NSARF), Taipei, Taiwan. Electronic address: tschu@ntu.edu.tw., Chawla LS; Department of Medicine, Veterans Affairs Medical Center, Washington, DC, USA. Electronic address: minkchawla@gmail.com.
Jazyk: angličtina
Zdroj: Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research [Value Health] 2020 Sep; Vol. 23 (9), pp. 1225-1234. Date of Electronic Publication: 2020 Aug 06.
DOI: 10.1016/j.jval.2020.01.024
Abstrakt: Objectives: Acute kidney injury (AKI) and acute kidney disease (AKD) are a continuum on a disease spectrum and frequently progress to chronic kidney disease. Benefits of nephrologist subspecialty care during the AKD period after AKI are uncertain.
Methods: Patients with AKI requiring dialysis who subsequently became dialysis independent and survived for at least 90 days, defined as the AKD period, were identified from the Taiwanese population's health insurance database. Cox proportional hazard models using death as the competing risk before and after propensity-score matching were applied to evaluate various endpoints.
Results: Among a total of 20 260 patients with AKI requiring dialysis who became dialysis independent, only 7550 (37.3%) patients were followed up with by a nephrologist (F/U nephrol group) during the AKD period. During a mean 4.04 ± 3.56 years of follow-up, the patients in the F/U nephrol group were more often administered statin, antihypertensives, angiotensin converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB), diuretics, antiplatelet agents, and antidiabetic agents. The patients in the F/U nephrol group had a lower mortality rate (hazard ratio [HR] = 0.87, P < .001) and were less likely to have major adverse cardiovascular events (MACE) (subdistribution HR [sHR] = 0.85, P < .001), congestive heart failure (CHF) (sHR = 0.81, P < .001), and severe sepsis (sHR = 0.88, P = .008) according to the Cox proportional model after adjusting for mortality as a competing risk. During the AKD period, an increase in the frequency of nephrology visits was associated with improved outcomes.
Conclusions: In this population-based cohort, even after weaning off acute dialysis, only a minority of patients visited a nephrologist during the AKD period. We showed that nephrology follow-up is associated with a decrease in MACE, CHF exacerbations, and sepsis, as well as lower mortality; thus it may improve outcomes in patients with AKD.
(Copyright © 2020 ISPOR–The Professional Society for Health Economics and Outcomes Research. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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