Although a multidisciplinary individual team approach (MTA) has been thought to help prevent the progression of diabetic nephropathy (DN), its efficacy on patient survival has not been fully examined. We compared the effect of an MTA on the hemodialysis (HD) course of 60 DN patients with that of 40 DN patients managed via a dietitian approach (DA) alone (total patients, n=100; 68 male, age, 61±12 years; 95 T2DM). In all cases, HD was initiated between January 2010 and June 2017. MTA staff members were doctors, dietitians, nurses, laboratory technologists, and pharmacists. The team provided broad education such as advice on nutrition, medication, medical exam, and foot care. In the MTA group, the hematocrit value was significantly better, and the difference between real body weight at the initiation HD and dry weight was significantly smaller (vs. DA group: 28.3±4.8% vs. 26.6±4.1% p=0.033, 6.4±5.6kg vs. 8.9±7.1kg p=0.036, respectively). The MTA group tended to have a lower CTR, lower cost per admission for HD induction and lower urinary sodium excretion in 24h urine collection (vs. DA group: 53.4±6.6% vs. 55.5±8.2% p=0.095, $14,861±8,222 vs. $18,693±14,149 p=0.064, 8.2±2.2g/day vs. 13.0±6.9g/day p=0.095, respectively). The number of rehospitalizations due to macroangiopathy after HD induction was smaller in the MTA group (Pearson 3.444, p=0.064). The frequency of death after HD was significantly lower in the MTA group (Pearson 4.575, p=0.032). A Kaplan-Meier survival analysis showed that the MTA group had superior patient survival (log rank 5.727, p=0.017).
In conclusion, the MTA provided prolonged survival and might prevent rehospitalization. Both might be resulted from predominant and non-inferior effects of an MTA on DN patients with HD; thus, further study is warranted to examine the combined effects of the predominant or non-inferior advantages of MTA in providing longer life expectancy in comparison to DA.
M. Hitomi: None. T. Sato: None. T. Moriya: None.
