Date: Monday, June 3, 2019
Session Name: Poster Session C: Kidney: Cardiovascular and Metabolic
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall C & D
*Purpose: Multidisciplinary clinics are the best approach for pre-dialysis patients (PDP), but few studies depict its impact in kidney transplant recipients (KTR), mostly through comparisons between multidisciplinary and non-multidisciplinary clinics.
*Methods: In a retrospective cohort study, we compared patient and kidney function survival, glomerular filtration rate (GFR) decline, prevalence of complications related to chronic kidney disease (CKD), percentage of patients and of clinical visits without treatment of those complications, and time within therapeutic goals, between 101 KTR and 101 propensity score-matched PDP, all followed by a multidisciplinary team, for 12-60 months. Variation of GFR was estimated by mixed generalized linear model, patient and kidney survival were assessed by Kaplan-Meier curves, and differences regarding treatment were compared through odds ratio or relative risk.
*Results: The cohorts had comparable GFR and prevalence of comorbidities. Anemia (38.6% vs 15.8%, RR 2.43, CI 1.46-4.06, p <0.001) and treatment for anemia (73.9% vs 11.3%, OR 0.15, CI 0.1-0.23, p <0.001) were more prevalent in KTR, but overall number of patients with untreated anemia was similar. Untreated hypercholesterolemia (15.7% vs 22.9%, OR 0.68, CI 0.52-0.89, p=0.005) was more common in PDP, but untreated hyperphosphatemia (56.1% vs 30.0%, RR 1.86, CI 1.01-3.44, p=0.044) and untreated hyperuricemia (60.4% vs 35.4%, RR 1.7, CI 1.31-2.21, p<0.001) were more common in KTR. Time within treatment goals was similar between groups, except diastolic blood pressure (83.4% vs 77.3%, RR 0.92, CI 0.88-0.97, p=0.002) and hypertrigliceridemia (67.7% vs 58.2%, OR 0.85, CI 0.78-0.93, p<0.001), longer controlled in PDP, and proteinuria (92.7% vs. 83.5%, RR 1.1, CI 1.05-1.16, p<0.001) and LDL cholesterol, longer controlled in KTR. Patient survival and GFR slope (0.81 mL/min/year in KTR vs 1.07 mL/min/year in PDP, p=0.48, CI -0.04-0.08) were similar between groups, but PDP progressed more often to dialysis (9.9% vs 6.9%, p<0.001).
*Conclusions: Differences in prevalence of some complications can be explained by a large number of incident patients in the PDP group and by adverse effects of immunosuppressive medication in KTR. We observed a good performance by the multidisciplinary model for treatment of CKD-related complications in KTR in comparison to PDP, suggesting that this model of assistance can contribute to improve the quality of clinical follow-up of KTR.
To cite this abstract in AMA style:Carminatti M, Fernandes NM, Colugnati FA, Sanders-Pinheiro H. Similar Quality in Chronic Kidney Disease Multidisciplinary Follow-Up between Kidney Transplant and Pre-Dialysis Patients [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/similar-quality-in-chronic-kidney-disease-multidisciplinary-follow-up-between-kidney-transplant-and-pre-dialysis-patients/. Accessed August 12, 2020.
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