VULNERABLE patients with advanced chronic kidney disease (CKD) such as older adults, may benefit more from multidisciplinary care compared to general nephrology care, and multidisciplinary care may be linked to more equitable care, according to a new study. Researchers attempted to understand the potential impact of multidisciplinary nephrology care on patient outcomes.
Surekha Annadanam, University of Michigan, Ann Arbor, USA, and colleagues conducted a cross-sectional study including 245 patients (mean age: 60 years; 48% male; 49% female; 3% transgender/no response/other). All patients had Stage 1-5 CKD and none of them were on dialysis or had received a transplant. Patients receiving general nephrology care (n=168) were only seen by nephrologist, while those receiving multidisciplinary care were seen by a nephrologist, dietitian, social worker, and pharmacist. The patients were tested on their kidney disease knowledge through a validated survey following care visits and were scored on a scale of 0–100%. This survey included CKD-specific knowledge, perception of overall health, perception of health status compared to 1 year ago, and kidney disease-related stress. The differences among the groups were identified through a Welch-2-sample- t-test, and linear regression model.
While there were no significant differences in outcomes between patients receiving general nephrology care and those receiving multidisciplinary care, researchers noted that patients in multidisciplinary care programmes were on average older than those receiving general nephrology care (64 years versus 58 years) and had more advanced kidney disease (66% with Stage 4-5 CKD versus 36%). Furthermore, the team noted that a team-based approach could be more equitable, as outcomes were similar in the two groups despite age differences and disease severity.
Annadanam concluded: “Our study suggests that multidisciplinary clinics may be able to provide more equitable care in terms of achieving some patient-centred outcomes for more vulnerable populations, specifically those who are older or who have more advanced CKD.” The findings also highlight the need for patient education, as well as the difference in stress patients feel about their diagnosis depending on age and race. Limitations of the study include the cross-sectional design, the assessment of CKD knowledge by asking for CKD stage instead of estimated glomerular filtration rate, and the convenience sample. The team hopes that these associations will be researched more in the future.