Although a multidisciplinary individual team approach (MTA) has been thought to help prevent the progress of diabetic nephropathy (DN), its efficacy has not been fully examined. We compared the effect of an MTA on the hemodialysis (HD) course of 51 DN patients with that of 34 DN patients managed via a dietitian approach (DA) alone (total patients, n=85; male, n=58; age, 62±12 years; T2DM, n=81). In all cases, HD was initiated between January 2010 and May 2016. MTA staff members were doctors, dietitians, nurses, laboratory technologists, and pharmacists. Each intervention took 15-30 min at an outpatient clinic on the day of doctor visits. The team provided advice on nutrition, medication, medical exam, foot care, self-monitoring, and self-management. In the MTA group, the annual number of intervention sessions was higher, the cardiothoracic ratio was lower, and the cost per admission for HD induction was lower in comparison to the DA group (5.0±5.5/year vs.2.0±2.0/year, P=0.004; 53.1±6.6% vs. 57.3±7.4%, p=0.009; and 1.55±0.85 vs. 2.04±0.15 million JPY, p=0.029). Four patients in the MTA group and 9 in the DA group died during the observation period (likelihood ratio 5.381, p=0.020). A Kaplan-Meier survival analysis showed that the MTA group had superior patient survival (log rank p=0.009). The number of patients who underwent 24-h corrected urine tests 6 months before HD was higher in the MTA group (n=20 vs. n=5, likelihood ratio 6.281, p=0.025), while the urinary sodium excretion in 24 h urine collection was lower in the MTA group (8.2±2.2 g/day vs. 13.0±6.9, P=0.011).The stepwise regression analysis showed that the MTA and DA classifications mostly affected patient survival at the final observation (F=7.20, p=0.014).
In conclusion, the MTA provided good clinical and economic results for DN patients through improved self-management and an improved clinical course, even when implemented after the initiation of HD.
M. Hitomi: None. T. Sato: None. T. Moriya: None.