Cardiovascular and Renal Outcomes in an Excellent Chronic Kidney Disease Clinic Compared with an Outpatient Clinic in a Primary Care Setting: A Retrospective Cohort Study. 2019

Noppawit Aiumtrakul, and Krischon Euswas, and Kitinan Phichedwanichskul, and Ram Rangsin, and Wisit Kaewput, and Bancha Satirapoj
Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok, Thailand.

BACKGROUND Chronic kidney disease (CKD) is associated with increased cardiovascular morbidity and mortality. In standard care, the physician attempts to control all known risk factors, but treatment goals are achieved with difficulty. Assistance by a multidisciplinary care team may improve outcomes. OBJECTIVE To compare the cardiovascular and renal endpoints between patients with CKD receiving care from excellent CKD and outpatient clinics. METHODS A retrospective cohort study was conducted in a primary care setting in Thailand. Patients with CKD stages 3 and 4 in excellent CKD (n = 96) and outpatient clinics (n = 192) were matched in a 1: 2 ratio with the propensity score. We collected data from electronic medical records concerning the incidences of primary composite outcomes including rapid renal progression, end-stage renal disease, myocardial infarction, congestive heart failure, stroke, and mortality. Multidisciplinary team care in the excellent CKD clinic consisted of physician, nurse, pharmacist, dietitian, physical therapist, and applied Thai traditional physician. The outpatient clinic consisted of physician care only. RESULTS Subjects' mean age was 64.54 ± 10.96 years, and 52.1% were female. During an average 49.63 ± 8.36 months of follow-up, 74 events occurred including 35 (47.30%) patients who experienced renal events, 29 (39.19%) who experienced cardiovascular events, and 10 (13.51%) who experienced loss of life. The Kaplan-Meier curve indicated a higher percentage of subjects without primary composite outcomes in the excellent CKD clinic than those in the outpatient clinic (66.85%; 95% CI 0.48-0.80 vs. 44.71%; 95% CI 0.29-0.60; p = 0.005). From multivariate analysis, the excellent CKD clinic group had a 64% lower risk for primary composite outcomes compared with those in the outpatient clinic (adjusted HR 0.36; 95% CI 0.18-0.74; p = 0.005). CONCLUSIONS A multidisciplinary care system can reduce composition outcomes including cardiovascular and renal outcomes for the growing CKD population. The optimal outcomes arise from the medical personnel's teamwork, not from one physician alone.

UI MeSH Term Description Entries

Related Publications

Noppawit Aiumtrakul, and Krischon Euswas, and Kitinan Phichedwanichskul, and Ram Rangsin, and Wisit Kaewput, and Bancha Satirapoj
January 2017, Canadian journal of kidney health and disease,
Noppawit Aiumtrakul, and Krischon Euswas, and Kitinan Phichedwanichskul, and Ram Rangsin, and Wisit Kaewput, and Bancha Satirapoj
April 2021, Mayo Clinic proceedings. Innovations, quality & outcomes,
Noppawit Aiumtrakul, and Krischon Euswas, and Kitinan Phichedwanichskul, and Ram Rangsin, and Wisit Kaewput, and Bancha Satirapoj
December 2023, Clinical pharmacology and therapeutics,
Noppawit Aiumtrakul, and Krischon Euswas, and Kitinan Phichedwanichskul, and Ram Rangsin, and Wisit Kaewput, and Bancha Satirapoj
October 2007, Osteopathic medicine and primary care,
Noppawit Aiumtrakul, and Krischon Euswas, and Kitinan Phichedwanichskul, and Ram Rangsin, and Wisit Kaewput, and Bancha Satirapoj
August 2019, BMC endocrine disorders,
Noppawit Aiumtrakul, and Krischon Euswas, and Kitinan Phichedwanichskul, and Ram Rangsin, and Wisit Kaewput, and Bancha Satirapoj
October 2021, BMC nephrology,
Noppawit Aiumtrakul, and Krischon Euswas, and Kitinan Phichedwanichskul, and Ram Rangsin, and Wisit Kaewput, and Bancha Satirapoj
December 2021, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association,
Noppawit Aiumtrakul, and Krischon Euswas, and Kitinan Phichedwanichskul, and Ram Rangsin, and Wisit Kaewput, and Bancha Satirapoj
September 2016, PLoS medicine,
Noppawit Aiumtrakul, and Krischon Euswas, and Kitinan Phichedwanichskul, and Ram Rangsin, and Wisit Kaewput, and Bancha Satirapoj
January 2006, Nursing standard (Royal College of Nursing (Great Britain) : 1987),
Noppawit Aiumtrakul, and Krischon Euswas, and Kitinan Phichedwanichskul, and Ram Rangsin, and Wisit Kaewput, and Bancha Satirapoj
January 2009, Journal of bone and mineral metabolism,
Copied contents to your clipboard!