Effectiveness of Multifaceted Care Approach on Adverse Clinical Outcomes in Nondiabetic CKD: A Systematic Review and Meta-analysis
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 analy...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2017-07-01
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| Series: | Kidney International Reports |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2468024917300372 |
| _version_ | 1818470977808367616 |
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| author | Aminu K. Bello Bilal Qarni Arian Samimi Julius Okel Trish Chatterley Ikechi G. Okpechi Ben Vandermeer Branko Braam |
| author_facet | Aminu K. Bello Bilal Qarni Arian Samimi Julius Okel Trish Chatterley Ikechi G. Okpechi Ben Vandermeer Branko Braam |
| author_sort | Aminu K. Bello |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-04-13T21:44:52Z |
| format | Article |
| id | doaj.art-d2dd66e0ba8f46bebdde74458823dcc6 |
| institution | Directory Open Access Journal |
| issn | 2468-0249 |
| language | English |
| last_indexed | 2024-04-13T21:44:52Z |
| publishDate | 2017-07-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Kidney International Reports |
| spelling | doaj.art-d2dd66e0ba8f46bebdde74458823dcc62022-12-22T02:28:38ZengElsevierKidney International Reports2468-02492017-07-012461762510.1016/j.ekir.2017.02.007Effectiveness of Multifaceted Care Approach on Adverse Clinical Outcomes in Nondiabetic CKD: A Systematic Review and Meta-analysisAminu K. Bello0Bilal Qarni1Arian Samimi2Julius Okel3Trish Chatterley4Ikechi G. Okpechi5Ben Vandermeer6Branko Braam7Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, CanadaDivision of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, CanadaDivision of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, CanadaDivision of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, CanadaJohn W. Scott Health Sciences Library, University of Alberta, Edmonton, CanadaDivision of Nephrology and Hypertension, University of Cape Town, Cape Town, South AfricaDepartment of Pediatrics, University of Alberta, Edmonton, CanadaDivision of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, CanadaThe 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.http://www.sciencedirect.com/science/article/pii/S2468024917300372multifaceted carenondiabetic CKDoutcomessystematic review |
| spellingShingle | Aminu K. Bello Bilal Qarni Arian Samimi Julius Okel Trish Chatterley Ikechi G. Okpechi Ben Vandermeer Branko Braam Effectiveness of Multifaceted Care Approach on Adverse Clinical Outcomes in Nondiabetic CKD: A Systematic Review and Meta-analysis Kidney International Reports multifaceted care nondiabetic CKD outcomes systematic review |
| title | Effectiveness of Multifaceted Care Approach on Adverse Clinical Outcomes in Nondiabetic CKD: A Systematic Review and Meta-analysis |
| title_full | Effectiveness of Multifaceted Care Approach on Adverse Clinical Outcomes in Nondiabetic CKD: A Systematic Review and Meta-analysis |
| title_fullStr | Effectiveness of Multifaceted Care Approach on Adverse Clinical Outcomes in Nondiabetic CKD: A Systematic Review and Meta-analysis |
| title_full_unstemmed | Effectiveness of Multifaceted Care Approach on Adverse Clinical Outcomes in Nondiabetic CKD: A Systematic Review and Meta-analysis |
| title_short | Effectiveness of Multifaceted Care Approach on Adverse Clinical Outcomes in Nondiabetic CKD: A Systematic Review and Meta-analysis |
| title_sort | effectiveness of multifaceted care approach on adverse clinical outcomes in nondiabetic ckd a systematic review and meta analysis |
| topic | multifaceted care nondiabetic CKD outcomes systematic review |
| url | http://www.sciencedirect.com/science/article/pii/S2468024917300372 |
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