Display options
Cite
Bello AK, Qarni B, Samimi A, et al. Effectiveness of Multifaceted Care Approach on Adverse Clinical Outcomes in Nondiabetic CKD: A Systematic Review and Meta-analysis. Kidney Int Rep. 2017;2(4):617-625doi: 10.1016/j.ekir.2017.02.007.
Bello, A. K., Qarni, B., Samimi, A., Okel, J., Chatterley, T., Okpechi, I. G., Vandermeer, B., & Braam, B. (2017). Effectiveness of Multifaceted Care Approach on Adverse Clinical Outcomes in Nondiabetic CKD: A Systematic Review and Meta-analysis. Kidney international reports, 2(4), 617-625. https://doi.org/10.1016/j.ekir.2017.02.007
Bello, Aminu K, et al. "Effectiveness of Multifaceted Care Approach on Adverse Clinical Outcomes in Nondiabetic CKD: A Systematic Review and Meta-analysis." Kidney international reports vol. 2,4 (2017): 617-625. doi: https://doi.org/10.1016/j.ekir.2017.02.007
Bello AK, Qarni B, Samimi A, Okel J, Chatterley T, Okpechi IG, Vandermeer B, Braam B. Effectiveness of Multifaceted Care Approach on Adverse Clinical Outcomes in Nondiabetic CKD: A Systematic Review and Meta-analysis. Kidney Int Rep. 2017 Feb 16;2(4):617-625. doi: 10.1016/j.ekir.2017.02.007. eCollection 2017 Jul. PMID: 29142980; PMCID: PMC5678655.
Copy Download .nbib Format: NLM
Share it on

Kidney Int Rep. 2017 Feb 16;2(4):617-625. doi: 10.1016/j.ekir.2017.02.007. eCollection 2017 Jul.

Effectiveness of Multifaceted Care Approach on Adverse Clinical Outcomes in Nondiabetic CKD: A Systematic Review and Meta-analysis.

Kidney international reports

Aminu K Bello, Bilal Qarni, Arian Samimi, Julius Okel, Trish Chatterley, Ikechi G Okpechi, Ben Vandermeer, Branko Braam

Affiliations

  1. Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Canada.
  2. John W. Scott Health Sciences Library, University of Alberta, Edmonton, Canada.
  3. Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa.
  4. Department of Pediatrics, University of Alberta, Edmonton, Canada.

PMID: 29142980 PMCID: PMC5678655 DOI: 10.1016/j.ekir.2017.02.007

Abstract

INTRODUCTION: The risk of major adverse events associated with chronic kidney disease (CKD) could potentially be reduced with effective medical interventions. The impact of multifaceted interventions as compared with usual care in patients with nondiabetic CKD is unclear. We performed a systematic review to analyze the impact of multifaceted interventions on reducing the risk of major adverse events in this population.

METHODS: Systematic review and meta-analysis. We searched MEDLINE, EMBASE, CINAHL and the Cochrane Library databases for medical literature published up to November 2016. Published original studies and abstracts were reviewed that reported on adult patients in a community or specialty care setting, with 2 or more CKD risk factors, treated with a combination of more than 2 interventions. We included randomized controlled trials, observational studies, and systematic reviews. Studies focused on diabetic patients were excluded. The intervention was defined as a treatment with a combination of 2 or more interventions compared with the usual care. The outcomes were defined as a reduction in the risk of adverse clinical outcomes (renal replacement therapy, all-cause hospitalizations, all-cause and cardiovascular mortality, cardiovascular events) as primary outcomes. Secondary outcomes were optimal risk factor control (attaining guideline concordant blood pressure, reduction of proteinuria, smoking cessation).

RESULTS: Five of the 5846 unique citations from our initial literature search met our study criteria. All identified studies reported on patients with CKD and their management. In comparison with usual care, multifaceted interventions tended to reduce all-cause mortality (risk ratio: 0.81, 95% confidence interval: 0.63-1.03) and were associated with a lower risk of progression to kidney failure requiring dialysis (risk ratio: 0.57, 95% confidence interval: 0.35-0.94). Multifaceted interventions were not associated with reducing risk of all-cause hospitalizations (risk ratio: 0.93, 95% confidence interval: 0.71-1.23) or improved blood pressure control (mean difference: -0.48, range: -2.5 to 1.55 mm Hg).

DISCUSSION: Multifaceted interventions targeting multiple risk factors tended to reduce the risk of all-cause mortality and reduced the risk to progress to end-stage kidney failure in patients with CKD. There is a need for high-quality studies that can rigorously evaluate a set of interventions targeting multiple domains of CKD management in the population with nondiabetic CKD due to paucity of data in the current published literature.

Keywords: multifaceted care; nondiabetic CKD; outcomes; systematic review

References

  1. Nephrol Dial Transplant. 2011 Nov;26(11):3560-6 - PubMed
  2. Lancet. 2010 Apr 10;375(9722):1296-309 - PubMed
  3. J Epidemiol Community Health. 1998 Jun;52(6):377-84 - PubMed
  4. JAMA. 2016 Jan 12;315 (2):164-74 - PubMed
  5. Lancet. 2012 Jan 14;379(9811):165-80 - PubMed
  6. Lancet. 2005 Jan 22-28;365(9456):331-40 - PubMed
  7. J Pediatr Health Care. 2011 Jan-Feb;25(1):1-2 - PubMed
  8. Int J Evid Based Healthc. 2012 Mar;10(1):53-9 - PubMed
  9. JAMA. 2006 Jul 26;296(4):427-40 - PubMed
  10. Kidney Int. 2014 Jan;85(1):49-61 - PubMed
  11. J Evid Based Med. 2015 Feb;8(1):2-10 - PubMed
  12. Eur J Intern Med. 2015 Oct;26(8):640-5 - PubMed
  13. Diabetes Metab. 2011 Dec;37(6):546-52 - PubMed
  14. Nephrol Dial Transplant. 2013 Mar;28(3):671-82 - PubMed
  15. Lancet. 2013 Jul 20;382(9888):260-72 - PubMed
  16. J Diabetes. 2009 Jun;1(2):83-9 - PubMed
  17. Curr Med Res Opin. 2011 Aug;27(8):1659-68 - PubMed
  18. Lancet. 2012 Jun 16;379(9833):2252-61 - PubMed
  19. Lancet. 2013 Jul 13;382(9887):158-69 - PubMed
  20. Clin J Am Soc Nephrol. 2011 Apr;6(4):704-10 - PubMed
  21. BMJ. 2011 Oct 18;343:d5928 - PubMed
  22. J Am Soc Nephrol. 2014 Feb;25(2):390-8 - PubMed
  23. Lancet. 2013 Jul 27;382(9889):353-62 - PubMed
  24. Ann Intern Med. 2013 Jun 4;158(11):825-30 - PubMed

Publication Types