미네랄 골질환 합병증을 가진 투석환자에서 다학제 팀 서비스의 임상적 성과
Clinical Outcomes of Multidisciplinary Team Care on the Regulation of Chronic Kidney Disease - Mineral and Bone Disorder (CKD-MBD) in Patients Undergoing Dialysis
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Background: Multidisciplinary team care (MTC) is a collaborative approach to treatment plan and ongoing care. We aimed to evaluate the clinical effect of MTC on the regulation of chronic kidney disease-mineral and bone disorder (CKD-MBD) complications in dialysis patients. Methods: This retrospective observational study was approved by the institutional review board. Among patients who have undergone dialysis at admission, the patients admitted to the nephrology ward were allocated to MTC group, and the others to usual care (UC) group. The MTC group had collaborative care by nephrologists, nurses, pharmacists, and nutritionists. The endpoints were the regulation of corrected calcium (cCa) and phosphate (P), the percent of patients in target level of cCa-P product (cCa×P), and the prescription rate of non-calcium based P-binders. Results: A total of 163 patients were included from January to December 2009. A significant difference was shown in the percentage of patients in target cCa×P level at admission (MTC vs. UC, 81.40% vs. 91.67%; P = 0.038), but there was no significant difference at discharge. During admission, the cCa and P levels of patients in only UC group were significantly changed. In addition, compared with UC group, patients in MTC group were more likely prescribed appropriate P-binders, when they had higher cCa×P levels than 55 mg2/dL2 (P <0.001). Conclusion: It was found that MTC had beneficial effect on improving the regulation of CKD-MBD and the appropriate phosphate binder uses. Therefore, application of the MTC is anticipated to enhance quality of clinical care in chronic diseases.
Abstract
Background: Multidisciplinary team care (MTC) is a collaborative approach to treatment plan and ongoing care. We aimed to evaluate the clinical effect of MTC on the regulation of chronic kidney disease-mineral and bone disorder (CKD-MBD) complications in dialysis patients. Methods: This retrospective observational study was approved by the institutional review board. Among patients who have undergone dialysis at admission, the patients admitted to the nephrology ward were allocated to MTC group, and the others to usual care (UC) group. The MTC group had collaborative care by nephrologists, nurses, pharmacists, and nutritionists. The endpoints were the regulation of corrected calcium (cCa) and phosphate (P), the percent of patients in target level of cCa-P product (cCa×P), and the prescription rate of non-calcium based P-binders. Results: A total of 163 patients were included from January to December 2009. A significant difference was shown in the percentage of patients in target cCa×P level at admission (MTC vs. UC, 81.40% vs. 91.67%; P = 0.038), but there was no significant difference at discharge. During admission, the cCa and P levels of patients in only UC group were significantly changed. In addition, compared with UC group, patients in MTC group were more likely prescribed appropriate P-binders, when they had higher cCa×P levels than 55 mg2/dL2 (P <0.001). Conclusion: It was found that MTC had beneficial effect on improving the regulation of CKD-MBD and the appropriate phosphate binder uses. Therefore, application of the MTC is anticipated to enhance quality of clinical care in chronic diseases.
참고문헌 (28)
- Makowsky MJ, "Collaboration between pharmacists, physicians and nurse practitioners: a qualitative investigation of working relationships in the inpatient medical setting", J Interprof Care, 23(2), pp.169~184 (2009)
- 이병구, "우리나라 약사의 팀 의료 현황과 활성화 방안", J Kor Soc Health-Syst Pharm, 25(2), pp.89~95 (2008)
- Yarnall KSH, "Family physicians as team leaders: “time” to share the care", Prev Chronic Dis, 6 (2009)
- Carter BL, "Deterioration of blood pressure control after discontinuation of a physician-pharmacist collaborative intervention", Pharmacotherapy, 30(3), pp.228~235 (2010)
- Carter BL, "Physician and pharmacist collaboration to improve blood pressure control", Arch Intern Med, 169(21), pp.1996~2002 (2009)
- Carter BL, "The potency of team-based care interventions for hypertension: a meta-analysis", Arch Intern Med, 169(19), pp.1748~1755 (2009)
- Kohn LT, "Academic Health Centers: Leading Change in the 21st Century", pp.65~76 (2003), National Academy Press
- Institute of Medicine (US) Committee on the Health Professions Education Summit, "Health Professions Education: A Bridge to Quality" (2003), National Academies Press
- Block GA, "Association of serum phosphorus and calcium X phosphate product with mortality risk in chronic hemodialysis patients: a national study", Am J Kidney Dis, 31, pp.607~617 (1998)
- Hruska KA, "Renal osteodystrophy", N Engl J Med, 333, pp.166~174 (1995)
- Martin KJ, "Metabolic bone disease in chronic kidney disease", J Am Soc Nephrol, 18, pp.875~885 (2007)
- Blacher J, "Arterial calcifications, arterial stiffness, and cardiovascular risk in end-stage renal disease", Hypertension, 38, pp.938~942 (2001)
- Haydar AA, "Coronary artery calcification and aortic pulse wave velocity in chronic kidney disease patients", Kidney Int, 65, pp.1790~1794 (2004)
- Melamed ML, "Changes in serum calcium, phosphate, and PTH and the risk of death in incident dialysis patients: a longitudinal study", Kidney Int, 70, pp.351~357 (2006)
- Noordzij M, "Mineral metabolism and cardiovascular morbidity and mortality risk: peritoneal dialysis patients compared with haemodialysis patients", Nephrol Dial Transplant, pp.2513~2520 (2006)
- Moe S, "Definition, evaluation, and classification of renal osteodystrophy: A position statement from Kidney Disease: Improving Global Outcomes (KDIGO)", Kidney Int, 69, pp.1945~1953 (2006)
- Unruh ML, "Skipped treatments, markers of nutritional nonadherence, and survival among incident hemodialysis patients", Am J Kidney Dis, 46, pp.1107~1116 (2005)
- Goldstein M, "Multidisciplinary predialysis care and morbidity and mortality of patients on dialysis", Am J Kidney Dis, 44(4), pp.706~714 (2004)
- Pai AB, "Reduced drug use and hospitalization rates in patients undergoing hemodialysis who received pharmaceutical care: a 2-year, randomized, controlled study", Pharmacotherapy, 29(12), pp.1433~1440 (2009)
- Koechler JA, "Indicators for the selection of ambulaory patients who warrant pharmacist monitoring", Am J Hosp Pharm, 46, pp.729~732 (1989)
- Manley HJ, "Medication-related problem in ambulatory hemodialysis patients: A pooled analysis", Am J Kidney Dis, 46(4), pp.669~680 (2005)
- Strand LM, "Drug-related problems: their structure and function", DICP, 24, pp.1093~1097 (1990)
- International Society of Nephrology, "KDIGO Clinical Practice Guideline for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD)", Kidney Int, 76(113), pp.S1~S132 (2009)
- Sesso R, "Late diagnosis of chronic renal failure and mortality on maintenance dialysis", Nephrol Dial Transplant, 11, pp.2417~2420 (1996)
- Levin NW, "Consequences of hyperphosphatemia and elevated levels of the calcium-phosphorus product in dialysis patients", Curr Opin Nephrol Hypertens, 10, pp.563~568 (2001)
- Friedman O, "The impact of prior multidisciplinary predialysis care on mineral metabolic control among chronic hemodialysis patients", Nephron Clin Pract, 110, pp.c229~c234 (2008)
- Rasgon SA, "Benefits of a multidisciplinary predialysis program in maintaining employment among patients on home dialysis", Adv Perit Dial, 12, pp.132~135 (1996)
- Obrador GT, "Pre-end-stage renal disease care in the United States: a state of disrepair", J Am Soc Nephrol, 9, pp.S44~S54 (1998)