Does a medical management program for CKD patients postpone renal replacement therapy and mortality? A 5-year-cohort study.

BACKGROUND: Many countries have started screening and prevention programs for chronic kidney disease (CKD). However, one of the main concerns of health authorities is whether management strategies for diagnosed CKD patients can decrease mortality or morbidity. This study aimed to investigate the effect of two competing clinical strategies of treatments under nephrologists' supervision compared with no treatment on the frequency of the need to start renal replacement therapy (RRT) and mortality in CKD patients.

METHODS: Our cohort comprised consecutive newly diagnosed patients with CKD in an outpatient clinic in Tehran between October 2002 and October 2011. CKD Patient enrollment occurred if two criteria of high plasma creatinine level and chronicity of renal disease by at least 3 months of clinical history or small sized kidneys in ultrasound findings were met. Demographic data and time of RRT or mortality in patients who had been followed up regularly were compared with those in the control group. The control group included those patients who did not attend a nephrology clinic to receive CKD management package for at least 1 year during the study period.

RESULTS: The cohort included 76 patients in the control group and 389 patients in the supervised group. The mean age of the patients was 61.33±14.9 years (16-95 years). The ratio of males/females was 1.47 (277/188). The mean follow-up in the control and supervised groups was 33.29±20.50 (7-111) and 36.03±25.24 (6-124) months , respectively, and the total patient years of follow-up was 1382.3. A substantial number of patients survived without RRT until the first year of follow up (96%) in both groups, but afterward, those in the control group had more deaths or need to start RRT in comparison with those who received medical advice (20 vs. 67 months; p= 0.029). This cohort also showed a higher survival and a longer time to show a GFR of less than 15 cc/min (84 vs 34 months, p<0.0001) in patients who had been under physician supervision compared with the control group.

CONCLUSIONS: Active follow-up of CKD patients appears to significantly decrease the risk of death or progression to end-stage renal disease and the requirement to start renal replacement therapy.