Clinical Study On The Progression Of Renal Disease In Multidisciplinary Care Of Chronic Kidney Disease

Objective:Establishing the Chronic kidney disease(CKD)multidisciplinary care team(MDC)and building CKD standard management delay the progression of CKD and acquire better blood pressure controlled goals.Methods:1.Literature about MDC was consult,then we established the MDC team and standard MDC process.2.In this prospective cohort study,based on the establishment of MDC team and standard MDC process,we compare the effectiveness of patients with CKD stage 2-5(non-dialysis)who was collected between 2017.9-2018.9 under MDC or traditional care.At baseline visit,socio-demographic characteristics and medical history were recorded.Clinical laboratory data were collected on the baseline,and then every visits.Starting renal replacement therapy(RRT)or the annual eGFR decrease more than 5ml/min/1.73m2 during the follow-up period was judged as renal function progression.Related data were compared in the end of follow-up.3.We studied 24h ambulatory blood pressure(ABP)characteristics and association between taking time of antihypertensive drugs with urinary protein excretion in CKD patients with hypertension.ABP results and related laboratory data of CKD inpatients in our hospital from 2018.1 to 2018.12 was collected and analyzed.Part of nondipper and reverse dipper among them was compared clinical laboratory data after changing at lease one antihypertensive drugs at bedtime three months.All data were entered into EXCEL form and analyzed using SPSS 24.0 software.Results:1.CKD specific outpatient service and the MDC team was established at September 2017 and the team member including nephrologist,nutritionist,pharmacist and nurses.Until January 2019,a total of patients with CKD was collected and cared regularly according to state of an illness.2.According to whether accept MDC,CKD patients were divided into MDC group(41 patients)and traditional care group(44 patients).Socio-demographic characteristics and laboratory data at the baseline are without difference in statistical analysis(P>0.05).(1)During the median follow-up of 275.51�68.38 days in MDC group and 300.82�121.33 days in traditional care group,the annual eGFR were-0.71(-5.83,4.24)ml/min/1.73m2 and-3.78(-13.08,-1.46)ml/min/1.73m2,while theoretical renal survival time were 4.12(1.94,6.10)years and 2.75(0.95,4.37)years respectively,showing significant differences(P<0.05).(2)The hemoglobin compliance rate in MDC group increased from 63.4%to 70.7%,while in traditional care group decreased from 70.5%to 47.7%,showing significant differences(P<0.05).3.CKD patients with hypertension,enrolled in the study of characteristics of ABP,with dipper 18(14.0%),nondipper 63(48.8%)and reverse dipper 48(37.2%).(1)Participants in the reverse dipper group was more likely to have higher 24h urine protein(2.82�2.48g/24h)compared with dipper and nondipper groups(dipper:24h upro:1.04�0.89g/24h,nondipper:24h upro:2.03�1.52g/24h)(P<0.05).(2)The significant of 24h urine protein reduction after 3 months of therapy was found at lease one antihypertensive drugs change at bedtime(2.14�2.21g VS 1.37�1.46g).Conclusion:1.The establishment of MDC team and standard management for CKD patients can effectively delay the disease progression and improve the compliance rate of hemoglobin.2.CKD patients with hypertension have a low prevalence of the dipper BP pattern compared with the normal people.The nondipper and reverse dipper pattern are associated with increased hypertensive target organ damage.Decrease in urinary protein excretion associated with taking time of antihypertensive drugs.