The effectiveness of an innovative shared care scheme in managing chronic kidney disease and the impact of routine nephrology care on the rate of progression
The effectiveness of an innovative shared care scheme in managing chronic kidney disease and the impact of routine nephrology care on the rate of progression
A retrospective review of the 1771 new referrals to one unit from 1997 to 2003 with mild stage 1-2 CKD (824) and moderate to severe stage 3-5 CKD (947). Patients were managed either in the hospital nephrology clinic (HC), or the shared care scheme (SCS) where nephrologists review patients remotely using regular biochemical tests and clinical data recorded in primary care.
1011(57%) patients with CKD referred to this single unit were enrolled in the SCS, 745(91%) with stage 1-2 CKD within an average of 12 days and 266(28%) with stage 3-5 CKD within 111 days of referral. In the latter the level of kidney function predicted SCD entry, whereas in the former this was of less importance than the general clinical state. In both the strongest predictor of enrolment was the degree of proteinuria. Non-attendance for SCS review was low and few required re-call to the HC. Beneficial changes in blood pressures and angiotensin system inhibitors were seen after referral in all groups. Although comparison is difficult due to their differing clinical characteristics, overall the SCS patients fared well with better adjusted survival than the HC group and lower rates of progression of CKD.
Analysis of the progression of CKD in the stage 3-5 CKD cohort showed rates of GFR decline (mls/min/1.73m2/year) slowed from 5.4(-13. to -2) before to -0.35(-3 to +3) after referral (p<0.001) and this slowing of decline was associated with significantly better adjusted survival (hazard ratio 0.55, 95% CI 0.40-0.75, p=<0.001). In stage 1-2 CKD few patients died and in the 25% who progressed to a GFR <60mls/min this did not affect outcomes.
University of Southampton
Jones, Chris
93ef9692-7414-40e6-adb5-948edb2b7424
2006
Jones, Chris
93ef9692-7414-40e6-adb5-948edb2b7424
Jones, Chris
(2006)
The effectiveness of an innovative shared care scheme in managing chronic kidney disease and the impact of routine nephrology care on the rate of progression.
University of Southampton, Doctoral Thesis.
Record type:
Thesis
(Doctoral)
Abstract
A retrospective review of the 1771 new referrals to one unit from 1997 to 2003 with mild stage 1-2 CKD (824) and moderate to severe stage 3-5 CKD (947). Patients were managed either in the hospital nephrology clinic (HC), or the shared care scheme (SCS) where nephrologists review patients remotely using regular biochemical tests and clinical data recorded in primary care.
1011(57%) patients with CKD referred to this single unit were enrolled in the SCS, 745(91%) with stage 1-2 CKD within an average of 12 days and 266(28%) with stage 3-5 CKD within 111 days of referral. In the latter the level of kidney function predicted SCD entry, whereas in the former this was of less importance than the general clinical state. In both the strongest predictor of enrolment was the degree of proteinuria. Non-attendance for SCS review was low and few required re-call to the HC. Beneficial changes in blood pressures and angiotensin system inhibitors were seen after referral in all groups. Although comparison is difficult due to their differing clinical characteristics, overall the SCS patients fared well with better adjusted survival than the HC group and lower rates of progression of CKD.
Analysis of the progression of CKD in the stage 3-5 CKD cohort showed rates of GFR decline (mls/min/1.73m2/year) slowed from 5.4(-13. to -2) before to -0.35(-3 to +3) after referral (p<0.001) and this slowing of decline was associated with significantly better adjusted survival (hazard ratio 0.55, 95% CI 0.40-0.75, p=<0.001). In stage 1-2 CKD few patients died and in the 25% who progressed to a GFR <60mls/min this did not affect outcomes.
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Published date: 2006
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Local EPrints ID: 466072
URI: http://eprints.soton.ac.uk/id/eprint/466072
PURE UUID: e0233140-4754-49d9-8f96-3676e31e8b55
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Date deposited: 05 Jul 2022 04:14
Last modified: 05 Jul 2022 04:14
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Author:
Chris Jones
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