# Effects of 1-week inpatient multidisciplinary care for chronic kidney disease prior to outpatient collaborative care

## TL;DR

A 1-week inpatient multidisciplinary care program for chronic kidney disease patients delays dialysis and reduces the need for a specific type of hemodialysis.

## Contribution

The study shows that inpatient multidisciplinary care before outpatient care significantly delays dialysis and reduces catheter-based hemodialysis.

## Key findings

- Patients who received inpatient care delayed dialysis initiation by about 17 months compared to those who did not.
- Inpatient care reduced the rate of hemodialysis using a central venous catheter by nearly half.
- Educational hospitalization was independently associated with reduced catheter-based hemodialysis.

## Abstract

Multidisciplinary care for Chronic Kidney Disease (CKD) has been reported to be effective in preventing deterioration of renal function and avoiding hemodialysis induction using a central venous catheter.

We included 171 patients who received dialysis at our department between October 2014 and June 2017. Patients were divided into two groups: an inpatient group who received inpatient multidisciplinary care for CKD (educational hospitalization) prior to outpatient collaborative care from their family physician and nephrologist, and a non-inpatient group who did not receive such care. We compared factors related to dialysis induction.

There was no significant difference in eGFR between the groups at the start of observation. The mean time from the start of observation to dialysis induction (inpatient group vs. non-inpatient group; 40.8 ± 2.8 vs. 23.9 ± 3.0 months, respectively; P < 0.001) and the rate of hemodialysis induction using a central venous catheter (22.5 vs. 47.1%, respectively; P = 0.002) were significantly different between the groups. Survival analysis showed that the time to dialysis induction was significantly longer in the inpatient group (P = 0.0001). Multivariate analysis revealed that educational hospitalization (odds ratio = 0.30 [95% CI 0.13, 0.67]) was significantly associated with hemodialysis induction using a central venous catheter.

Educational hospitalization prior to outpatient collaborative care is beneficial for preventing hemodialysis induction using a central venous catheter and postponing dialysis induction.

The online version contains supplementary material available at 10.1007/s10157-024-02496-5.