Is There an Interest in Implementing a Multidisciplinary Clinic or Renal Care Network to Improve the Prognosis of Patients with Chronic Kidney Disease?

Nicolas Rognant

Nephrology Department, Hospices Civild de Lyon and Univetrsity of Lyon, Lyon, France

Disclosure: No potential conflict of interest.
Citation: EMJ Neph. 2013;1:60-67.

Abstract

Chronic kidney disease (CKD) is highly prevalent in several countries and is associated with the incidence of end-stage renal disease (ESRD) and also with premature morbidity and mortality, especially from cardiovascular origin. However, efficient treatments have existed for two decades but have not led to major decrease in either ESRD incidence or premature death of CKD patients. Some authors suggested that the deliverance of suboptimal care can explain, at least partly, these disappointing findings. Several observational studies support this idea by showing that some recommended medications are under- prescribed in CKD patients, and that some patients are sometimes insufficiently monitored for clinical and biological parameters. Therefore, new models of renal care deliverance have been developed, trying to optimise patient treatment with the hope that it could positively impact their outcomes. In this article, we will focus on the multidisciplinary clinic and the renal care network models and we will review the results of the main studies that sought to test the impact of these new structures on patient’s prognosis. Although most of these studies are observational, they predominantly show a positive effect on renal prognosis and also survival. However, the only one randomised clinical trial with long-term follow-up failed to find any positive effect despite increased cost. Therefore, more evidence, based on results of randomised clinical trials, is needed before a wide implementation of this kind of program.

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