Multidisciplinary Strategies in the Management of Early Chronic Kidney Disease

Mobile health management among end stage renal disease patients: a scoping review

Aims

The health management of end-stage renal disease patients is a complicated process, and mobile health management technology provides a new choice for the health management of end-stage renal disease patients. The scope of clinical studies on mobile health management for patients with end-stage renal disease was reviewed, and found that about mobile health management problems existing in the literature were identified to provide ideas for subsequent mobile health management research.

Methods

The databases Web of Science, PubMed, The Cochrane Library, Embase, CNKI, Wan Fang Data, BMJ, and VIP were systematically searched for studies on Mobile health management among end-stage renal disease in adult and adolescent patients or children undergoing kidney replacement therapy. The search covered the period from the inception of the databases to June 20, 2023. Two independent reviewers conducted the literature screening process. Following eligibility screening, a total of 38 papers were included for data extraction and descriptive analysis.

Results

A total of 38 studies from 14 countries were finally included. The majority of which were interventional trials. The platforms used in these studies included remote monitoring systems, apps, websites, mobile phones or tablets, and social platforms. These platforms provided patients with a wide range of services, including disease management, behavioral intervention, social support, and follow-up care. Most studies focused on patient clinical indicators, patient experience, quality of life, and healthcare costs.

Conclusion

Our findings that mobile health management has been widely used in disease management of end-stage renal disease patients, with rich management content and many evaluation indicators. Future studies should strengthen the evaluation of patients' mental health, quality of life, and healthcare costs. Additionally, developing a clinical decision support system would enable mobile health management to play a more effective role in end-stage renal disease patients.

Determinants of early chronic kidney disease in patients with recently diagnosed type 2 diabetes mellitus: a retrospective study from the Taiwan Diabetes Registry

BACKGROUND

We tried to identify the risk factor associate with early chronic kidney disease (CKD) in recently diagnosed type 2 diabetes mellitus patients by utilizing real-world data from Taiwan Diabetes Registry.

MATERIALS AND METHODS

Patients with type 2 diabetes mellitus recently diagnosed within 1 year. We divided the study participants into control group and early CKD group. Early CKD was defined as either CKD stage G1 with albuminuria, CKD stage G2 with albuminuria, or CKD stage G3a regardless of albuminuria (Urine-albumin to creatinine ratio (UACR) ≥ 3 mg/mmol). Control group was defined as CKD G1 or CKD G2 without albuminuria. Logistic regression analyses were used to compare differences in clinical characteristics between the subgroups. Linear regression models were employed to examine the factors predicting estimated glomerular filtration rate (eGFR) and UACR.

RESULTS

Total 2217 patients with recently diagnosed type 2 diabetes mellitus were included. 1545 patients were assigned to control group and 618 patients were assigned to the early CKD group. Age (odds ratio (OR) 1.215, 95% confidence interval [CI] 1.122-1.316), systolic blood pressure (OR 1.203, 95% CI 1.117-1.296), glycated hemoglobin (OR 1.074, 95% CI 1.023-1.129) and triglyceride (OR 2.18, 95% CI 1.485-3.199) were found to be significant risk factors. Further, presence of bidirectional association between UACR and eGFR was found.

CONCLUSIONS

We reported factors associated with early CKD in recently diagnosed type 2 diabetes mellitus patients. Variables that associated with eGFR and UACR were identified respectively, included a mutual influence between UACR and eGFR.

The influence of multidisciplinary team clinic on the prognosis of patients with chronic kidney disease

Chronic kidney disease (CKD) seriously affects the quality of life and survival time of patients, and even affects social and national economic development. In China, how to effectively control the disease process of CKD outpatients has not been determined. A retrospective analysis was made to 100 patients with CKD. Fifty patients treated with traditional clinical treatment were in the control group, and the other fifty patients treated with multidisciplinary team (MDT) clinical treatment were in the MDT group. The prognosis of the two groups after treatment was compared, including glomerular filtration rate (GFR), number of renal replacement treatments, and mortality, to evaluate the actual effect of MDT clinic. CKD patients in the MDT group received the MDT clinic for 24 months. There was no significant difference between GFR and serum creatinine level before treatment, and the quality of life was significantly higher than before. In the control group, the GFR declined more dramatically, the serum creatinine level was higher, and the quality of life was lower than before (P < 0.05). The frequency of renal replacement therapy and mortality in the MDT group were significantly lower than those in the control group (P < 0.05). MDT clinic can effectively improve the prognosis of patients with CKD, delay kidney disease progression, and reduce mortality.

The National Kidney Foundation of Illinois KidneyMobile: a mobile resource for community based screenings of chronic kidney disease and its risk factors

BACKGROUND

Early detection and treatment of chronic kidney disease (CKD) and its risk factors improves outcomes; however, many high-risk individuals lack access to healthcare. The National Kidney Foundation of Illinois (NKFI) developed the KidneyMobile (KM) to conduct community-based screenings, provide disease education, and facilitate follow-up appointments for diabetes, hypertension, and CKD.

METHODS

Cross-sectional design. Adults > = 18 years of age participated in NKFI KM screenings across Illinois between 2005 and 2011. Sociodemographic and medical history were self-reported using structured interviews; laboratory data and blood pressure were assessed using standard procedures.

RESULTS

Among 20,770 participants, mean age was 53.5 years, 68% were female, 49% were African-American or Hispanic, 21% primarily spoke Spanish, and at least 27% lacked health insurance. Seventy-eight percent of participants with elevated blood pressure (≥ 140/90 mmHg) were aware of having hypertension, 93% of participants with abnormal blood glucose (fasting glucose > 126 mg/dl or a random glucose of > 200 mg/dL) were aware of having diabetes, and 19% of participants with albuminuria (> 30 mg/gm) were aware of having CKD. In participants reporting hypertension, 47% had blood pressure ≥ 140/90 mmHg, and in those reporting diabetes, 56% had blood glucose ≥ 130 mg/dl (fasting) or ≥ 180 mg/dl (random). Among 4937 participants with abnormal screening findings that participated in follow-up interviews, 69% reported having further medical evaluation.

CONCLUSIONS

A high-risk disadvantaged population is being reached by the NKFI KidneyMobile and connected with healthcare services. A significant proportion of participants were newly informed of having abnormal results suggestive of diabetes, hypertension, and/or CKD or that their diabetes and hypertension were inadequately controlled.

Provision of care for chronic kidney disease by non-nephrologists in a developing nation: a national survey

OBJECTIVES

The prevalence of chronic kidney disease (CKD) in developing countries has increased dramatically. This study aimed to explore the practice patterns of non-dialysis-dependent CKD care in an affluent developing country.

SETTINGS

Primary and specialised healthcare facilities of public and private sectors in the United Arab Emirates.

PARTICIPANTS

159 non-nephrologist physicians practising in the United Arab Emirates.

INTERVENTIONS

A 28-item online self-administered questionnaire based on CKD clinical practice guidelines.

PRIMARY AND SECONDARY OUTCOME MEASURES

The physicians' approach to identifying and managing patients with CKD.

RESULTS

The survey was completed by 159 non-nephrologists, of whom 135 reported having treated patients with CKD. Almost all the respondents screen patients with hypertension and diabetes for CKD, but one-third of them do not screen patients with cardiovascular disease and elderly patients for CKD. The use of accurate CKD screening tests (estimated glomerular filtration rate and albumin/creatinine ratio) was suboptimal (77% and 59% of physicians used the procedures, respectively). One-third of the physicians do not offer treatment with inhibitors of the renin-angiotensin system to patients with CKD, and only 66% offer antilipid treatment. In general, the primary healthcare physicians are more familiar than secondary healthcare physicians with the diagnosis and management of patients with CKD.

CONCLUSIONS

We identified substantial physician-declared deficiencies in the practice of identifying and managing early CKD. Integration of quality CKD care within the healthcare system is required to face the increasing burden of CKD in the United Arab Emirates and possibly in other developing nations.

The self-management experience of patients with type 2 diabetes and chronic kidney disease: A qualitative study

BACKGROUND

The purpose of this study was to explore views related to the self-management of type 2 diabetes and chronic kidney disease.

METHODS

We conducted three semi-structured focus groups in participants with type 2 diabetes and chronic kidney disease. Interviews were transcribed, coded, and analyzed using thematic analysis. Credibility was supported through triangulation of data sources and the use of multiple investigators from different disciplines.

RESULTS

Twenty-three adults participated. Three major themes were identified: emotional reactions to health state, the impact of family dynamics on self-management, and the burden of self-management regimens. Family dynamics were found to be a barrier and support to self-management, while complicated self-management regimens were found to be a barrier. Additionally, participants expressed several emotional reactions related to their CKD status, including regret related to having developed CKD and distress related both to their treatment regimens and the future possibility of dialysis.

CONCLUSIONS

This exploratory study of patients with type 2 diabetes and chronic kidney disease describes barriers and supports to self-management and emotional reactions to chronic kidney disease status. Future research should confirm these findings in a larger population and should include family members and/or health care providers to help further define problems with self-management in patients with type 2 diabetes and chronic kidney disease.

Animal model of chronic kidney disease using a unilateral technique of renal ischemia and reperfusion in White New Zealand rabbits

PURPOSE

To establish a model of chronic kidney disease in White New Zealand rabbits, using an exclusive unilateral technique of renal ischemia and reperfusion.

METHODS

Twenty males White New Zealand rabbits were used. All animals were subjected to the following: pre-surgical blood collection (1st collection) for creatinine and urea serum analysis, left renal ischemia and reperfusion surgery technique, another blood sample was collected after 6 weeks post surgery (2nd collection), the last blood sample (3rd collection) blood sample was taken 11 weeks post surgery (pre-euthanasia), euthanasia and withdrawal of right and left kidney for histopathological analysis.

RESULTS

The creatinine levels after surgery was statistically significant higher in the 3rd collection, regarding the 1st and 2nd collection (p<0.05). A significant statistic increase for urea was showed only in the 2nd collection (p<0.05) when compared to the 1st and 3rd collections. Histopathological analysis showed bilateral lesions in the renal tissue, consistent to the process of ischemia and reperfusion.

CONCLUSION

This exclusive unilateral technique of renal ischemia and reperfusion without nephrectomy in White New Zealand rabbits, showed effectiveness in getting an animal model of chronic kidney disease.