Multidisciplinary care in patients with chronic kidney disease: A systematic review and meta-analysis

Su Ming Wang, Lien Cheng Hsiao, I. Wen Ting, Tung Min Yu, Chih Chia Liang, Huey Liang Kuo, Chiz Tzung Chang, Jiung Hsiun Liu, Che Yi Chou*, Chiu Ching Huang

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

64 Scopus citations

Abstract

Background Multidisciplinary care (MDC) was widely used in multiple chronic illnesses but the effectiveness of MDC in patients with chronic kidney disease (CKD) was inconclusive. The aim of this meta-analysis is to estimate the effectiveness of MDC for CKD. Methods We searched PubMed, Web of Science, Google Scholar, Cochrane Library, and China Journal Full-text Database for relevant articles published in English or Chinese. Studies investigating MDC and non-MDC in patients with CKD were included. Random effect model was used to compare all-cause mortality, dialysis, risk of temporal catheterization, and hospitalization in the two treatment entities. Results We analyzed 8853 patients of 18 studies in patients with CKD stages 3-5, aged 63 ± 12 years. MDC was associated with lower risk of all-cause mortality with an odds ratio (OR) of 0.52 [95% confidence interval (CI): 0.44-0.88, p = 0.01], mainly in cohort studies. MDC was associated with a lower risk of starting dialysis (p = 0.02) and lower risk of temporal catheterization for dialysis (p < 0.01). MDC was not associated with a higher chance of choosing peritoneal dialysis (p = 0.18) or a lower chance of hospitalization for dialysis (p = 0.13). Conclusions Limited evidence from randomized controlled trials is currently available to support the benefit of MDC in patients with CKD. MDC is associated with lower all-cause mortality, lower risk of starting dialysis, and lower risk of temporal catheterization for dialysis in cohort studies. MDC is not associated with a higher chance of choosing peritoneal dialysis or a lower chance of hospitalization for dialysis. More studies are needed to determine the optimal professional that should be included in MDC.

Original languageEnglish
Pages (from-to)640-645
Number of pages6
JournalEuropean Journal of Internal Medicine
Volume26
Issue number8
DOIs
StatePublished - 10 2015
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2015 European Federation of Internal Medicine.

Keywords

  • Chronic kidney disease
  • Dialysis
  • Meta-analysis
  • Multidisciplinary care

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