The Effect of Medical Cooperation in the CKD Patients: 10-Year Multicenter Cohort Study.

Autor:	Onishi Y; Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan.; Department of Comprehensive Therapy for Chronic Kidney Disease, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan., Uchida HA; Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan.; Department of Chronic Kidney Disease and Cardiovascular Disease, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan., Maeshima Y; Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan.; Advanced Medical Engineering Research Institute, University of Hyogo, Himeji 670-0914, Japan.; Olba Healthcare Holdings Inc., Okayama 700-0907, Japan., Okuyama Y; Japanese Red Cross Society Himeji Hospital, Himeji 670-8540, Japan., Otaka N; Kagawa Prefectural Central Hospital, Takamatsu 760-8557, Japan., Ujike H; Kagawa Prefectural Central Hospital, Takamatsu 760-8557, Japan., Tanaka K; Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan., Takeuchi H; Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan., Tsuji K; Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan., Kitagawa M; National Hospital Organization Okayama Medical Center, Okayama 701-1154, Japan., Tanabe K; Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan., Morinaga H; Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan.; Department of Comprehensive Therapy for Chronic Kidney Disease, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan., Kinomura M; Okayama Saiseikai General Hospital, Okayama 700-8511, Japan., Kitamura S; Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan., Sugiyama H; Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan.; Department of Medical Care Work, Kawasaki College of Allied Health Professions, Okayama 700-8505, Japan., Ota K; National Hospital Organization Okayama Medical Center, Okayama 701-1154, Japan., Maruyama K; Okayama Saiseikai General Hospital, Okayama 700-8511, Japan., Hiramatsu M; Okayama Saiseikai General Hospital, Okayama 700-8511, Japan.; Okayama Saiseikai Outpatient Center Hospital, Okayama 700-0013, Japan., Oshiro Y; Kawasaki Medical School General Medical Center, Okayama 700-8505, Japan., Morioka S; Okayama Central Hospital, Okayama 700-0017, Japan., Takiue K; Okayama City Hospital, Okayama 700-0962, Japan., Omori K; Shigei Medical Research Hospital, Okayama 701-0202, Japan., Fukushima M; Shigei Medical Research Hospital, Okayama 701-0202, Japan., Gamou N; Japanese Red Cross Okayama Hospital, Okayama 700-0941, Japan., Hirata H; Akebono Clinic, Okayama 702-8056, Japan., Sato R; Sato Clinic, Okayama 700-0864, Japan., Makino H; Okayama University, Okayama 700-8530, Japan., Wada J; Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan.
Jazyk:	angličtina
Zdroj:	Journal of personalized medicine [J Pers Med] 2023 Mar 26; Vol. 13 (4). Date of Electronic Publication: 2023 Mar 26.
DOI:	10.3390/jpm13040582
Abstrakt:	Introduction: While chronic kidney disease (CKD) is one of the most important contributors to mortality from non-communicable diseases, the number of nephrologists is limited worldwide. Medical cooperation is a system of cooperation between primary care physicians and nephrological institutions, consisting of nephrologists and multidisciplinary care teams. Although it has been reported that multidisciplinary care teams contribute to the prevention of worsening renal functions and cardiovascular events, there are few studies on the effect of a medical cooperation system. Methods: We aimed to evaluate the effect of medical cooperation on all-cause mortality and renal prognosis in patients with CKD. One hundred and sixty-eight patients who visited the one hundred and sixty-three clinics and seven general hospitals of Okayama city were recruited between December 2009 and September 2016, and one hundred twenty-three patients were classified into a medical cooperation group. The outcome was defined as the incidence of all-cause mortality, or renal composite outcome (end-stage renal disease or 50% eGFR decline). We evaluated the effects on renal composite outcome and pre-ESRD mortality while incorporating the competing risk for the alternate outcome into a Fine-Gray subdistribution hazard model. Results: The medical cooperation group had more patients with glomerulonephritis (35.0% vs. 2.2%) and less nephrosclerosis (35.0% vs. 64.5%) than the primary care group. Throughout the follow-up period of 5.59 ± 2.78 years, 23 participants (13.7%) died, 41 participants (24.4%) reached 50% decline in eGFR, and 37 participants (22.0%) developed end-stage renal disease (ESRD). All-cause mortality was significantly reduced by medical cooperation (sHR 0.297, 95% CI 0.105-0.835, p = 0.021). However, there was a significant association between medical cooperation and CKD progression (sHR 3.069, 95% CI 1.225-7.687, p = 0.017). Conclusion: We evaluated mortality and ESRD using a CKD cohort with a long-term observation period and concluded that medical cooperation might be expected to influence the quality of medical care in the patients with CKD.
Databáze:	MEDLINE
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