Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshida-Konoe-Cho, Sakyo-Ku, Kyoto, 606-8501, Japan.
Department of Nephrology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
BMC Nephrol. 2024 Mar 25;25(1):114. doi: 10.1186/s12882-024-03550-w.
Diabetic kidney disease (DKD) is the most common disease among patients requiring dialysis for the first time in Japan. Multidisciplinary care (MDC) may prevent the progression of kidney failure. However, the effectiveness and timing of MDC to preserve kidney function in patients with DKD is unclear. Therefore, the aim of this study was to investigate whether MDC for patients with DKD affects the preservation of kidney function as well as the timing of MDC in clinical practice.
In this retrospective cohort study, we identified patients with type 2 diabetes mellitus and DKD from April 2012 to January 2020 using a nationwide Japanese healthcare record database. The fee code for medical guidance to prevent dialysis in patients with diabetes was used to distinguish between the MDC and non-MDC groups. The primary outcome was a 40% decline in the estimated glomerular filtration rate, and secondary outcomes were death, hospitalization, permanent dialysis, kidney failure with replacement therapy, and emergency temporary catheterization. Propensity score matching was performed, and Kaplan-Meier and multivariable Cox regression analyses were performed.
Overall, 9,804 eligible patients met the inclusion criteria, of whom 5,614 were matched for the main analysis: 1,039 in the MDC group, and 4,575 in the non-MDC group. The primary outcome did not differ between the groups (hazard ratio: 1.18, [95% confidence interval: 0.99-1.41], P = 0.07). The groups also did not differ in terms of the secondary outcomes. Most patients with DKD received their first MDC guidance within 1 month of diagnosis, but most received guidance only once per year.
Although we could not demonstrate the effectiveness of MDC on kidney function in patients with DKD, we clarified the characteristics of such patients assigned the fee code for medical guidance to prevent dialysis related to diabetes.
在日本，糖尿病肾病（DKD）是首次需要透析的患者中最常见的疾病。多学科护理（MDC）可能会阻止肾衰竭的进展。然而，在 DKD 患者中，MDC 对保护肾功能的有效性及其在临床实践中的时机尚不清楚。因此，本研究旨在探讨 MDC 是否会影响 DKD 患者的肾功能保护，以及 MDC 在临床实践中的时机。
本回顾性队列研究使用全国性日本医疗记录数据库，从 2012 年 4 月至 2020 年 1 月，确定了患有 2 型糖尿病和 DKD 的患者。使用预防糖尿病患者透析的医疗指导费用代码来区分 MDC 和非 MDC 组。主要结局是估算肾小球滤过率下降 40%，次要结局是死亡、住院、永久性透析、肾衰竭伴替代治疗和紧急临时导管插入术。进行倾向评分匹配，并进行 Kaplan-Meier 和多变量 Cox 回归分析。
共有 9804 名符合纳入标准的合格患者，其中 5614 名进行了主要分析的匹配：MDC 组 1039 名，非 MDC 组 4575 名。两组主要结局无差异（风险比：1.18，[95%置信区间：0.99-1.41]，P=0.07）。两组次要结局也无差异。大多数 DKD 患者在诊断后 1 个月内接受了首次 MDC 指导，但大多数患者每年仅接受一次指导。
尽管我们无法证明 MDC 对 DKD 患者肾功能的有效性，但我们阐明了与糖尿病相关的透析预防医疗指导费用代码分配患者的特征。
