A prospective clinical trial of specialist renal nursing in the primary care setting to prevent progression of chronic kidney: a quality improvement report

作者: Rachael C Walker , Mark R Marshall , Nick R Polaschek

DOI: 10.1186/1471-2296-15-155

关键词:

摘要: Early detection and effective management of risk factors can potentially delay progression chronic kidney disease (CKD) to end-stage disease, decrease mortality morbidity from cardiovascular (CV) disease. We evaluated a specialist nurse-led intervention in the primary care setting address accepted study sample adults at ‘high CKD progression’, defined as uncontrolled type II diabetes and/or hypertension history poor clinic attendance. The was non-controlled quality improvement with pre- post- comparisons test feasibility potential effectiveness. Patients within two practices were screened recruited study. Fifty-two patients enrolled, 36 completing 12-months follow-up. involved series sessions led by nephrology Nurse Practitioner assistance practice nurses. These included assessment, education planned medication lifestyle changes. outcome measured proteinuria (ACR), secondary outcomes estimated glomerular filtration rate (eGFR) 5-year absolute CV risk. Several ‘intermediary’ also including: blood pressure, serum total cholesterol, glycosylated haemoglobin (HbA1c), body mass index (BMI), prevalence active smoking, variety self-management domains, prescription. Analysis data performed using linear logistic regression appropriate. There significant ACR (average −6.75 mg/mmol per month) over course small but eGFR reduction 5 year Blood HbA1c all decreased significantly. Adherence advice improved although there no change BMI. Self-management significantly across relevant domains. results suggest that collaborative model between renal nurses clinicians may improve for death. Further larger, controlled studies are warranted definitively determine effectiveness costs this intervention. Australian New Zealand Clinical Trials Registry number: ACTRN12613000791730

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