TITLE:
Effectiveness of an Secondary Prevention Program in Chronic Kidney Disease
AUTHORS:
Carlos Enrique Yepes Delgado, Yanett Marcela Montoya Jaramillo, Beatriz Elena Orrego Orozco, Paulina Bernal Ramírez, Luz Denise González, José Miguel Abad Echeverri, María Patricia Arbeláez Montoya
KEYWORDS:
Chronic Kidney Disease; Renal Protection Program; Effectiveness; Clinical Markers; Progression of Renal Damage; Renal Replacement Program
JOURNAL NAME:
Open Journal of Nephrology,
Vol.3 No.3,
September
9,
2013
ABSTRACT: Background: There are many programs which focus on
late-stage chronic kidney disease (CKD), and it is considered that further
evidence needs to be generated regarding the effectiveness of the programs used
before renal replacement therapy. Study Design: A cohort study. Settings &
Participants: Patients over 15 years of age who had been diagnosed with CKD
according to the KDOQI (Kidney Disease Outcomes Quality Initiative) guidelines
and who had undergone conventional treatment (CT) or a renal protection program
(RPP). These were patients of two Colombian health insurance
companies. Predictors: Age, sex, marital status, comorbidities, CKD stage, and
clinical indicators. Outcomes: First CKD progression, and need for renal
replacement therapy (RRT). Measures: Clinical marker. Results: The RPP is
structurally and functionally different from the CT. It offers the
interdisciplinary management of patients, a greater number of medical
appointments, and patients start to receive treatment at younger ages and at
earlier stages of their condition. The clinical markers of the patients
following the RPP are within adequate ranges, and their renal function is less
impaired, despite the differences in basal conditions. Upon finishing the
study, we found that patients who received CT had a higher risk of receiving
nephrotoxic drugs and not receiving nephroprotective drugs. The explanatory variables
for the first progression were age, stage, history of dyslipidemia, and
hemoglobin, potassium, and albumin levels. These variables, together with
glycemia levels were also valid for RRT, except for history of dyslipidemia, as
it was not significant. Upon adjusting for the explanatory variables, it was
found that belonging to the RPP and attending more appointments had a
protective effect in the process of controlling renal damage. Limitations: A
possible selection bias. Conclusions: Belonging to a structured renal
protection program is an effective way to keeping the clinical markers associated
with renal impairment within normal ranges.