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Cochrane Central Register of Controlled Trials

Augmented Nurse Care Management in CKD Stages 4 to 5: a Randomized Trial
PubMed

American journal of kidney diseases, 2017, 70(4), 498‐505 | added to CENTRAL: 31 October 2017 | 2017 Issue 10
https://doi.org/10.1053/j.ajkd.2017.02.366 Copy DOI

Fishbane S, Agoritsas S, Bellucci A, Halinski C, Shah HH, Sakhiya V, Balsam L

Links: PubMed

Abstract

BACKGROUND: Outcomes for patients with late‐stage chronic kidney disease (CKD) in the United States are suboptimal. There is poor
education and preparation for end‐stage kidney disease, as well as a high rate of hospitalization in this group of patients.

STUDY DESIGN: A randomized, parallel‐group, 2‐arm, controlled trial.

SETTING & PARTICIPANTS: The study was conducted at 3 sites: a clinic of an academic medical center, a public hospital academic
clinic, and a community‐based private practice. All participants had late‐stage CKD (stages 4‐5 CKD). Patients were excluded only if
they had significant cognitive impairment.

INTERVENTION: The care management intervention involved nurse care manager coordination aided by the use of a disease‐based
informatics system for monitoring patients' clinical status, enhancing CKD education, and facilitating preparation for end‐stage
kidney disease. The comparison control group received usual late‐stage CKD care alone.

OUTCOMES: The primary outcome was rate of hospitalization.

MEASUREMENTS: Rates of preemptive transplantation, home dialysis, hemodialysis (HD) starts without a hospitalization, and HD
therapy initiation rates with catheters or with functioning accesses.

RESULTS: 130 patients were randomly assigned. The hospitalization rate was significantly lower in the intervention group versus
controls: 0.61 versus 0.92 per year, respectively (incidence rate ratio, 0.66; 95% CI, 0.43‐0.99; P=0.04). Peritoneal dialysis or
preemptive transplantation was the initial end‐stage kidney disease treatment in 11 of 30 (37%) participants receiving the
intervention versus 3 of 29 (10%) receiving usual care. Among HD starts, treatment was initiated without hospitalization in 11 of 19
(58%) participants in the intervention group versus 6 of 26 (23%) in the control group. At the time of HD therapy initiation, a catheter
was present in 7 of 19 (37%) participants in the intervention group versus 18 of 26 (69%) in the control group. A functioning
arteriovenous access was in place in 10 of 19 (53%) participants in the intervention group and 7 of 26 (27%) in the control group
LIMITATIONS: Moderate sample size, limited geographic scope.

CONCLUSIONS: The augmented nurse care management intervention resulted in reduced hospitalizations in late‐stage CKD and
there were suggestions of improved end‐stage kidney disease preparation. Given suboptimal outcomes in late‐stage CKD, care
management interventions could potentially improve patient outcomes.

Information

DOI of original publication:

https://doi.org/10.1053/j.ajkd.2017.02.366 Copy DOI
Database:
Cochrane Central Register of Controlled Trials (CENTRAL)
Date Added to CENTRAL:
31 October 2017
Issue Added to CENTRAL:
2017 Issue 10
Source:
American journal of kidney diseases
Year of Publication:
2017
Volume:
70
Issue:
4
Pages:
498‐505
Accession Number:
PUBMED 28396108
Language:
English
Publication Type:
Journal Article; Multicenter Study; Randomized Controlled Trial
ID Number:
CN-01413289

Keywords

Medical Subject Headings (MeSH) Keywords

Kidney Failure, Chronic [nursing];
Nursing Process;
Renal Insu iciency, Chronic [*nursing];
Severity of Illness Index;

Medical Subject Headings Check Words

Aged;
Female;
Humans;
Male;
Middle Aged;