Long-term effectiveness of a primary care practice facilitation program for chronic kidney disease management: an extended follow-up of a cluster-randomized FROM-J study

  • Toshiyuki Imasawa
    Department of Nephrology , National Hospital Organization Chiba-Higashi National Hospital, Nitonacho, Chuo-ku Chiba City, Chiba, Japan
  • Chie Saito
    Department of Nephrology, Faculty of Medicine, University of Tsukuba , Tennodai, Tsukuba, Ibaraki, Japan
  • Hirayasu Kai
    Department of Nephrology, Faculty of Medicine, University of Tsukuba , Tennodai, Tsukuba, Ibaraki, Japan
  • Kunitoshi Iseki
    Okinawa Heart and Renal Association (OHRA) , Aja, Naha, Okinawa, Japan
  • Junichiro James Kazama
    Department of Nephrology and Hypertension, Fukushima Medical University , Hikariga-oka, Fukushima, Japan
  • Yugo Shibagaki
    Division of Nephrology and Hypertension, Department of Internal Medicine, St Marianna University School of Medicine , Sugao, Miyamae-ku, Kawasaki, Kanagawa, Japan
  • Hitoshi Sugiyama
    Department of Human Resource Development of Dialysis Therapy for Kidney Disease, Okayama University Graduate School of Medicine , Dentistry and Pharmaceutical Sciences, Shikata-cho, Kita-ku, Okayama, Japan
  • Daisuke Nagata
    Division of Nephrology, Department of Internal Medicine, Jichi Medical University , Yakushiji, Shimotsuke-shi, Tochigi, Japan
  • Ichiei Narita
    Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences , Asahimachi-dori, Chuo-ku, Niigata City, Niigata, Japan
  • Tomoya Nishino
    Department of Nephrology, Nagasaki University Hospital , Sakamoto, Nagasaki, Japan
  • Hajime Hasegawa
    Department of Nephrology and Hypertension , Saitama Medical Center, , Kamoda, Kawagoeshi, Saitama, Japan
  • Hirokazu Honda
    Division of Nephrology, Department of Medicine, Showa University School of Medicine , Hatanodai, Shinagawa-ku, Tokyo, Japan
  • Shoichi Maruyama
    Department of Nephrology, Nagoya University Graduate School of Medicine , 65 Tsurumai-cho, Showa-ku, Nagoya, Japan
  • Mariko Miyazaki
    Department of Nephrology, Endocrinology, and Vascular Medicine, Tohoku University Graduate School of Medicine , Seiryo-machi, Aoba-ku, Sendai, Miyagi, Japan
  • Masashi Mukoyama
    Department of Nephrology, Kumamoto University Graduate School of Medical Sciences , Honjo, Chuo-ku, Kumamoto, Japan
  • Hideo Yasuda
    Internal Medicine 1, Hamamatsu University School of Medicine , Handayama, Higashi-ku, Hamamatsu city, Shizuoka, Japan
  • Takashi Wada
    Department of Nephrology and Laboratory Medicine, Kanazawa University , Takaramachi, Kanazawa, Ishikawa, Japan
  • Yuichi Ishikawa
    Department of Food Sciences, College of Life Sciences, Ibaraki Christian University , Omika, Hitachi, Ibaraki, Japan
  • Ryoya Tsunoda
    Department of Nephrology, Faculty of Medicine, University of Tsukuba , Tennodai, Tsukuba, Ibaraki, Japan
  • Kei Nagai
    Department of Nephrology, Faculty of Medicine, University of Tsukuba , Tennodai, Tsukuba, Ibaraki, Japan
  • Reiko Okubo
    Department of Health Care Policy and Health Economics, Faculty of Medicine, University of Tsukuba , Tennodai, Tsukuba, Ibaraki, Japan
  • Masahide Kondo
    Department of Health Care Policy and Health Economics, Faculty of Medicine, University of Tsukuba , Tennodai, Tsukuba, Ibaraki, Japan
  • Junichi Hoshino
    Nephrology Center, Toranomon Hospital, Toranomon , Minato-ku, Tokyo, Japan
  • Kunihiro Yamagata
    Department of Nephrology, Faculty of Medicine, University of Tsukuba , Tennodai, Tsukuba, Ibaraki, Japan

抄録

<jats:title>ABSTRACT</jats:title> <jats:sec> <jats:title>Background</jats:title> <jats:p>Practice facilitation program by multidisciplinary care for primary care physicians (PCPs) is expected to improve chronic kidney disease (CKD) outcomes, but there is no clear evidence of its long-term effectiveness. We have previously performed a cluster-randomized controlled trial for 3.5 years (the Frontier of Renal Outcome Modifications in Japan (FROM-J) study) with two arms—group A without the program and group B with the program. We aimed to assess the long-term effectiveness of the practice facilitation program on CKD outcomes via an extended 10-year follow-up of the FROM-J study.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>We enrolled patients who were in the FROM-J study. The primary composite endpoint comprised cardiovascular disease (CVD), renal replacement therapy initiation and a 50% decrease in the estimated glomerular filtration rate (eGFR). The secondary endpoints were survival rate, eGFR decline rate and collaboration rate between PCPs and nephrologists.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>The occurrence of the primary composite endpoint tended to be lower in group B (group A: 27.1% versus group B: 22.1%, P = 0.051). Furthermore, CVD incidence was remarkably lower in group B (group A: 10.5% versus group B: 6.4%, P = 0.001). Although both mortality and the rate of eGFR decline were identical between both groups, the eGFR decline rate was significantly better in group B than in group A only in patients with stage G3a at enrollment (group A: 2.35 ± 3.87 mL/min/1.73 m2/year versus group B: 1.68 ± 2.98 mL/min/1.73 m2/year, P = 0.02). The collaboration rate was higher in group B.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>The CKD practice facilitation program for PCPs reliably decreases CVD events and may reduce the progression of cases to end-stage kidney disease.</jats:p> </jats:sec>

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