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Association between Multidisciplinary Care and Survival for Elderly Patients with Chronic Kidney Disease

Brenda R. Hemmelgarn^*,, Braden J. Manns^*,,, Jianguo Zhang^*, Marcello Tonelli^,, Scott Klarenbach^,, Michael Walsh^*, Bruce F. Culleton^* for the Alberta Kidney Disease Network

Departments of ^* Medicine and Community Health Sciences, University of Calgary, Calgary, and Institute of Health Economics and Department of Medicine, University of Alberta, Edmonton, Alberta, Canada

Address correspondence to: Dr. Brenda Hemmelgarn, Division of Nephrology, Foothills Hospital, 1403 29th St. NW, Calgary, Alberta, Canada, T2N 2T9. Phone: 403-944-2745; Fax: 403-944-2876; E-mail: brenda.hemmelgarn{at}calgaryhealthregion.ca

Received for publication August 15, 2006. Accepted for publication December 11, 2006.

The effectiveness of multidisciplinary care (MDC) in improving health outcomes for patients with chronic kidney disease (CKD) is uncertain. This study sought to determine the association among MDC, survival, and risk for hospitalization among elderly outpatients with CKD. A total of 6978 patients who were 66 yr and older and had CKD were identified between July 1 and December 31, 2001, and followed to December 31, 2004; 187 (2.7%) were followed in an MDC clinic. Logistic regression was used to determine the propensity score (probability of MDC) for each patient, and MDC and non-MDC patients then were matched 1:1 on the basis of their score. A Cox model was used to determine the association between MDC and risk for death and hospitalization. After adjustment for age, gender, baseline GFR, diabetes, and comorbidity score, there was a 50% reduction in the risk for death for the MDC compared with the non-MDC group (hazard ratio [HR] 0.50; 95% confidence interval [CI] 0.35 to 0.71). There was no difference in the risk for all-cause (HR 0.83; 95% CI 0.64 to 1.06) or cardiovascular-specific hospitalization (HR 0.76; 95% CI 0.54 to 1.06) for the MDC compared with the non-MDC group. In conclusion, it was found that MDC was associated with a significant reduction in the risk for all-cause mortality and, although not statistically significant, a trend toward a reduction in risk for all-cause and cardiovascular-specific hospitalizations. The benefits of MDC and an assessment of their economic impact should be tested in a randomized, controlled trial.

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Copyright © 2008 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673