TY - JOUR
T1 - Interdisciplinary Care and Preparedness for Kidney Failure Management in a High-Risk Population
AU - Johns, Tanya S.
AU - Prudhvi, Kalyan
AU - Motechin, Rachel A.
AU - Sedaliu, Kaltrina
AU - Estrella, Michelle M.
AU - Stark, Allison
AU - Bauer, Carolyn
AU - Golestaneh, Ladan
AU - Boulware, L. Ebony
AU - Melamed, Michal L.
N1 - Funding Information:
Tanya S. Johns, MD, MHS, Kalyan Prudhvi, MD, Rachel A. Motechin, BA, Kaltrina Sedaliu, MD, Michelle M. Estrella, MD, MHS, Allison Stark MD, MBA, Carolyn Bauer, MD, Ladan Golestaneh, MD, MS, L. Ebony Boulware, MD, MPH, and Michal L. Melamed, MD, MHS. Research idea and study design: LEB, MLM, MME, TSJ; data acquisition: AS, KP, KS, MLM, RAM, TSJ; statistical analysis and interpretation of data: KP, MLM, MME, TSJ; supervision or mentorship: CB, MLM, MME, LEB, LG, TSJ. Each author contributed important intellectual content during manuscript drafting or revision and accepts accountability for the overall work by ensuring that questions pertaining to the accuracy or integrity of any portion of the work are appropriately investigated and resolved. Dr Johns was supported by a Mentored Career Development Award, KL2TR001071. MME has research funding from Bayer, Inc. and has received a consulting honorarium from Boehringer-Ingelheim. LG serves on the Clinical Events Committee at the Cardiovascular Research Institute funded by Medtronic. We would like to thank Montefiore's Department of Medicine Chair and Division Chief for supporting the Kidney Care Program. We would also like to thank our Care Management Organization and nurse practitioners, Terrian Smith-Jules and Gracy Sebastian. Special thanks to all the nephrologists at Montefiore. Received August 31, 2021. Evaluated by 3 external peer reviewers, with direct editorial input by the Statistical Editor and the Editor-in-Chief. Accepted in revised form January 10, 2022.
Funding Information:
MME has research funding from Bayer, Inc. and has received a consulting honorarium from Boehringer-Ingelheim. LG serves on the Clinical Events Committee at the Cardiovascular Research Institute funded by Medtronic.
Publisher Copyright:
© 2022 The Authors
PY - 2022/5
Y1 - 2022/5
N2 - Rationale & Objective: Interdisciplinary care may improve health outcomes in patients with chronic kidney disease (CKD). Few studies have evaluated this model of health care delivery in racial and ethnic minorities. Study Design: Retrospective cohort study. Setting & Participants: Incident end-stage kidney disease (ESKD) patients at Montefiore Medical Center from October 1, 2013, to October 31, 2019. Exposure: Pre-ESKD interdisciplinary care. Outcomes: Pre-ESKD transplant listing and optimal kidney replacement therapy (KRT) start (use of arteriovenous access at hemodialysis initiation, outpatient hemodialysis start, preemptive transplant, or peritoneal dialysis as the first modality). Analytical Approach: We constructed multivariable logistic regression models adjusted for sociodemographic and clinical factors to determine the odds of transplant listing and optimal KRT start between interdisciplinary versus the usual care group. Results: Of the 295 incident ESKD patients included in our study, 84 received interdisciplinary care and 211 received usual nephrology care. The mean age was 59.9 years (standard deviation, 13.9 years), 47% were women, and 87% were African American or Hispanic. Baseline characteristics were similar between the groups, except that the interdisciplinary care group had a lower prevalence of hypertension (60% vs 75%). Compared with usual care, a higher proportion of patients in the interdisciplinary care group were listed for kidney transplant (44% vs 16%) and had an optimal KRT start (53% vs 44%). Receipt of interdisciplinary care was associated with a higher odds (OR, 5.73; 95% CI, 2.78-11.80; P < 0.001) of transplant listing compared with usual care after adjusting for important sociodemographic and clinical factors. The odds of an optimal KRT start also favored interdisciplinary care (OR, 1.60; 95% CI, 0.88-2.89; P = 0.12) but did not achieve statistical significance. Limitations: The study was non-randomized and had a small sample size. Conclusions: Interdisciplinary care is associated with better ESKD preparedness compared with usual nephrology care alone in racial and ethnic minorities. Larger studies are needed to determine the effectiveness of interdisciplinary care in patients with advanced CKD.
AB - Rationale & Objective: Interdisciplinary care may improve health outcomes in patients with chronic kidney disease (CKD). Few studies have evaluated this model of health care delivery in racial and ethnic minorities. Study Design: Retrospective cohort study. Setting & Participants: Incident end-stage kidney disease (ESKD) patients at Montefiore Medical Center from October 1, 2013, to October 31, 2019. Exposure: Pre-ESKD interdisciplinary care. Outcomes: Pre-ESKD transplant listing and optimal kidney replacement therapy (KRT) start (use of arteriovenous access at hemodialysis initiation, outpatient hemodialysis start, preemptive transplant, or peritoneal dialysis as the first modality). Analytical Approach: We constructed multivariable logistic regression models adjusted for sociodemographic and clinical factors to determine the odds of transplant listing and optimal KRT start between interdisciplinary versus the usual care group. Results: Of the 295 incident ESKD patients included in our study, 84 received interdisciplinary care and 211 received usual nephrology care. The mean age was 59.9 years (standard deviation, 13.9 years), 47% were women, and 87% were African American or Hispanic. Baseline characteristics were similar between the groups, except that the interdisciplinary care group had a lower prevalence of hypertension (60% vs 75%). Compared with usual care, a higher proportion of patients in the interdisciplinary care group were listed for kidney transplant (44% vs 16%) and had an optimal KRT start (53% vs 44%). Receipt of interdisciplinary care was associated with a higher odds (OR, 5.73; 95% CI, 2.78-11.80; P < 0.001) of transplant listing compared with usual care after adjusting for important sociodemographic and clinical factors. The odds of an optimal KRT start also favored interdisciplinary care (OR, 1.60; 95% CI, 0.88-2.89; P = 0.12) but did not achieve statistical significance. Limitations: The study was non-randomized and had a small sample size. Conclusions: Interdisciplinary care is associated with better ESKD preparedness compared with usual nephrology care alone in racial and ethnic minorities. Larger studies are needed to determine the effectiveness of interdisciplinary care in patients with advanced CKD.
KW - Interdisciplinary or multidisciplinary care
KW - chronic kidney disease
KW - health care delivery
KW - transplant
UR - http://www.scopus.com/inward/record.url?scp=85127982779&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85127982779&partnerID=8YFLogxK
U2 - 10.1016/j.xkme.2022.100450
DO - 10.1016/j.xkme.2022.100450
M3 - Article
AN - SCOPUS:85127982779
SN - 2590-0595
VL - 4
JO - Kidney Medicine
JF - Kidney Medicine
IS - 5
M1 - 100450
ER -