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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
biochemistry, genetics and molecular biology
Effectiveness of Multifaceted Care Approach on Adverse Clinical Outcomes in Nondiabetic CKD: A Systematic Review and Meta-analysis
Advances in Clinical Chemistry, Volume 81, Year 2017
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Description
Introduction The risk of major adverse events associated with chronic kidney disease (CKD) could potentially be reduced with effective medical interventions. The impact of multifaceted interventions as compared with usual care in patients with nondiabetic CKD is unclear. We performed a systematic review to analyze the impact of multifaceted interventions on reducing the risk of major adverse events in this population. Methods Systematic review and meta-analysis. We searched MEDLINE, EMBASE, CINAHL and the Cochrane Library databases for medical literature published up to November 2016. Published original studies and abstracts were reviewed that reported on adult patients in a community or specialty care setting, with 2 or more CKD risk factors, treated with a combination of more than 2 interventions. We included randomized controlled trials, observational studies, and systematic reviews. Studies focused on diabetic patients were excluded. The intervention was defined as a treatment with a combination of 2 or more interventions compared with the usual care. The outcomes were defined as a reduction in the risk of adverse clinical outcomes (renal replacement therapy, all-cause hospitalizations, all-cause and cardiovascular mortality, cardiovascular events) as primary outcomes. Secondary outcomes were optimal risk factor control (attaining guideline concordant blood pressure, reduction of proteinuria, smoking cessation). Results Five of the 5846 unique citations from our initial literature search met our study criteria. All identified studies reported on patients with CKD and their management. In comparison with usual care, multifaceted interventions tended to reduce all-cause mortality (risk ratio: 0.81, 95% confidence interval: 0.63–1.03) and were associated with a lower risk of progression to kidney failure requiring dialysis (risk ratio: 0.57, 95% confidence interval: 0.35–0.94). Multifaceted interventions were not associated with reducing risk of all-cause hospitalizations (risk ratio: 0.93, 95% confidence interval: 0.71–1.23) or improved blood pressure control (mean difference: −0.48, range: −2.5 to 1.55 mm Hg). Discussion Multifaceted interventions targeting multiple risk factors tended to reduce the risk of all-cause mortality and reduced the risk to progress to end-stage kidney failure in patients with CKD. There is a need for high-quality studies that can rigorously evaluate a set of interventions targeting multiple domains of CKD management in the population with nondiabetic CKD due to paucity of data in the current published literature. © 2017 International Society of Nephrology
Available Materials
https://efashare.b-cdn.net/share/pmc/articles/PMC5678655/bin/mmc1.doc
https://efashare.b-cdn.net/share/pmc/articles/PMC5678655/bin/mmc2.docx
Authors & Co-Authors
Bello, Aminu Kasarawa
Canada, Edmonton
University of Alberta
Qarni, Bilal
Canada, Edmonton
University of Alberta
Samimi, Arian
Canada, Edmonton
University of Alberta
Okel, Julius
Canada, Edmonton
University of Alberta
Okpechi, Ikechi Gareth
South Africa, Cape Town
University of Cape Town
Vandermeer, Ben W.
Canada, Edmonton
University of Alberta
Braam, Branko
Canada, Edmonton
University of Alberta
Statistics
Citations: 1
Authors: 7
Affiliations: 2
Identifiers
Doi:
10.1016/j.ekir.2017.02.007
ISSN:
00652423
Research Areas
Noncommunicable Diseases
Study Design
Randomised Control Trial
Cross Sectional Study
Study Approach
Systematic review