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Cochrane Central Register of Controlled Trials

Nurse practitioner care improves renal outcome in patients with CKD
PubMed Embase

Journal of the American Society of Nephrology : JASN, 2014, 25(2), 390‐398 | added to CENTRAL: 30 April 2014 | 2014 Issue 4
https://doi.org/10.1681/ASN.2012121222 Copy DOI

Peeters MJ, van Zuilen AD, van den Brand JA, Bots ML, van Buren M, Ten Dam MA, Kaasjager KA, Ligtenberg G, Sijpkens YW, Sluiter HE,
van de Ven PJ, Vervoort G, Vleming LJ, Blankestijn PJ, Wetzels JF
Links: PubMed PubMed Central

Abstract

Treatment goals for patients with CKD are o en unrealized for many reasons, but support by nurse practitioners may improve risk
factor levels in these patients. Here, we analyzed renal endpoints of the Multifactorial Approach and Superior Treatment E icacy in
Renal Patients with the Aid of Nurse Practitioners (MASTERPLAN) study a er extended follow‐up to determine whether strict
implementation of current CKD guidelines through the aid of nurse practitioners improves renal outcome. In total, 788 patients with
moderate to severe CKD were randomized to receive nurse practitioner support added to physician care (intervention group) or
physician care alone (control group). Median follow‐up was 5.7 years. Renal outcome was a secondary endpoint of the MASTERPLAN
study. We used a composite renal endpoint of death, ESRD, and 50% increase in serum creatinine. Event rates were compared with
adjustment for baseline serum creatinine concentration and changes in estimated GFR were determined. During the randomized
phase, there were small but significant di erences between the groups in BP, proteinuria, LDL cholesterol, and use of aspirin, statins,
active vitamin D, and antihypertensive medications, in favor of the intervention group. The intervention reduced the incidence of the
composite renal endpoint by 20% (hazard ratio, 0.80; 95% confidence interval, 0.66 to 0.98; P=0.03). In the intervention group, the
decrease in estimated GFR was 0.45 ml/min per 1.73 m(2) per year less than in the control group (P=0.01). In conclusion, additional
support by nurse practitioners attenuated the decline of kidney function and improved renal outcome in patients with CKD.

Information
DOI of original publication:
https://doi.org/10.1681/ASN.2012121222 Copy DOI
Database:
Cochrane Central Register of Controlled Trials (CENTRAL)
Date Added to CENTRAL:
30 April 2014
Issue Added to CENTRAL:
2014 Issue 4
Source:
Journal of the American Society of Nephrology : JASN
Year of Publication:
2014
Volume:
25
Issue:
2
Pages:
390‐398
Correspondence Details:
M.J. Peeters, Department of Nephrology, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen,
Netherlands. E‐mail: Mieke.Peeters@radboudumc.nl
Accession Number:
PUBMED 24158983; EMBASE 372260706
Language:
English
Publication Type:
Journal Article; Randomized Controlled Trial; Research Support, Non‐U.S. Gov't
ID Number:
CN-00978385

Keywords

Medical Subject Headings (MeSH) Keywords

Ambulatory Care Facilities [statistics & numerical data];

Antihypertensive Agents [therapeutic use];
Aspirin [therapeutic use];
Biomarkers;
Cholesterol, LDL [blood];
Creatinine [blood];
Follow‐Up Studies;
Guideline Adherence;
Hydroxymethylglutaryl‐CoA Reductase Inhibitors [therapeutic use];
Kidney Failure, Chronic [epidemiology, prevention & control];
Nurse Practitioners [*statistics & numerical data];
O ice Visits [statistics & numerical data];
Patient Care Team;
Physicians;
Proteinuria [epidemiology, etiology];
Renal Insu iciency, Chronic [blood, *nursing, therapy, urine];
Treatment Outcome;
Vitamin D [therapeutic use];

Medical Subject Headings Check Words

Aged;
Female;
Humans;
Male;
Middle Aged;

Embase Keywords

adult; aged; albuminuria; article; blood pressure measurement; body mass; calcium blood level; cardiovascular disease; *chronic
kidney disease; controlled study; creatinine blood level; creatinine clearance; death; diabetic nephropathy; disease severity; end
stage renal disease; female; follow up; histopathology; human; incidence; interstitial nephritis; kidney function; kidney
transplantation; major clinical study; male; microalbuminuria; middle aged; *nurse practitioner; *nursing care; outcome assessment;
physical activity; physician; practice guideline; priority journal; proteinuria; randomized controlled trial; risk factor; smoking; sodium
intake; young adult; acetylsalicylic acid; angiotensin receptor antagonist; antihypertensive agent; creatinine/ec [Endogenous
Compound]; dipeptidyl carboxypeptidase inhibitor; hemoglobin/ec [Endogenous Compound]; hemoglobin A1c/ec [Endogenous
Compound]; hydroxymethylglutaryl coenzyme A reductase inhibitor; low density lipoprotein cholesterol/ec [Endogenous
Compound]; vitamin D