TY - JOUR
T1 - Progression of stages 3b-5 chronic kidney disease-Preliminary results of Taiwan National Pre-ESRD Disease Management Program in Southern Taiwan
AU - Lin, Chun Mei
AU - Yang, Ming Chin
AU - Hwang, Shang Jyh
AU - Sung, Junne Ming
PY - 2013/12
Y1 - 2013/12
N2 - Background/Purpose: The outcomes and their predictors, and rates of estimated glomerular filtration rate (eGFR) changes among Taiwanese, an ethnic Chinese population, with chronic kidney disease (CKD) stages 3b-5, enrolled in a nationwide pre-end-stage renal disease (pre-ESRD) management program that have not been previously reported. Methods: This study focused on a cohort of patients enrolled in the Taiwan's pre-ESRD disease management program from Southern Taiwan, including 4061 CKD 3b-5 patients who received more than 12 weeks of follow-up from 2007 to 2010. The decline rates of eGFR, outcomes, and the predictors of initiating dialysis were analyzed. Results: The study participants consisted of patients who were 70.1±12.3 years old, of whom 56.4% were male, 46.3% were diabetic, and 72.1% were hypertensive. The mean annual eGFR changes were 0.47±0.42mL/min/1.73m2/year, -1.27±0.32mL/min/1.73m2/year, and -2.69±0.39mL/min/1.73m2/year for stages 3b, 4, and 5, respectively; however, more rapid declines were noted in diabetic patients. The Kaplan-Meier analyses revealed that the probabilities of patients remaining alive and free of dialysis treatment for CKD stage 3b, 4, and 5 without or with diabetes were 89.46% versus 84.65%, 79.88% versus 55.68%, and 34.42% versus 9.64%, respectively, during 42 months of follow-up. Male gender, diabetes, lower baseline eGFR, higher systolic blood pressure, lower hematocrit, and albumin levels were the significant risk factors for initiating dialysis. Conclusion: Even though we cannot conclude with certainty that the Taiwan pre-ESRD disease management program is beneficial in slowing the progression of CKD stages 3b-5, our preliminary results seem to suggest this trend. Furthermore, the program may be improved by integrating it with other programs, such as those on diabetes and hypertension, thus making it a more patient-centered, multidisciplinary program.
AB - Background/Purpose: The outcomes and their predictors, and rates of estimated glomerular filtration rate (eGFR) changes among Taiwanese, an ethnic Chinese population, with chronic kidney disease (CKD) stages 3b-5, enrolled in a nationwide pre-end-stage renal disease (pre-ESRD) management program that have not been previously reported. Methods: This study focused on a cohort of patients enrolled in the Taiwan's pre-ESRD disease management program from Southern Taiwan, including 4061 CKD 3b-5 patients who received more than 12 weeks of follow-up from 2007 to 2010. The decline rates of eGFR, outcomes, and the predictors of initiating dialysis were analyzed. Results: The study participants consisted of patients who were 70.1±12.3 years old, of whom 56.4% were male, 46.3% were diabetic, and 72.1% were hypertensive. The mean annual eGFR changes were 0.47±0.42mL/min/1.73m2/year, -1.27±0.32mL/min/1.73m2/year, and -2.69±0.39mL/min/1.73m2/year for stages 3b, 4, and 5, respectively; however, more rapid declines were noted in diabetic patients. The Kaplan-Meier analyses revealed that the probabilities of patients remaining alive and free of dialysis treatment for CKD stage 3b, 4, and 5 without or with diabetes were 89.46% versus 84.65%, 79.88% versus 55.68%, and 34.42% versus 9.64%, respectively, during 42 months of follow-up. Male gender, diabetes, lower baseline eGFR, higher systolic blood pressure, lower hematocrit, and albumin levels were the significant risk factors for initiating dialysis. Conclusion: Even though we cannot conclude with certainty that the Taiwan pre-ESRD disease management program is beneficial in slowing the progression of CKD stages 3b-5, our preliminary results seem to suggest this trend. Furthermore, the program may be improved by integrating it with other programs, such as those on diabetes and hypertension, thus making it a more patient-centered, multidisciplinary program.
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U2 - 10.1016/j.jfma.2013.10.021
DO - 10.1016/j.jfma.2013.10.021
M3 - Article
C2 - 24309170
AN - SCOPUS:84890138734
SN - 0929-6646
VL - 112
SP - 773
EP - 782
JO - Journal of the Formosan Medical Association
JF - Journal of the Formosan Medical Association
IS - 12
ER -