Background: It still remains unclear as to whether or not multidisciplinary individual team approach (MTA) affects the decline of kidney function in persons with diabetic kidney disease (DKD). We examined the effects of MTA on 24 DKD subjects compared with effects on 24 control subjects with DKD who are managed by dietitian approach alone (DA) between January 2012 and December 2021.
Methods: The team was composed of doctors, nurses (CDE, RN) and dietitians (CDE, RD). The team provided broad education, including advice on medication, medical diet therapy, management of home blood pressure, SMBG, weight measurement, self-check of edema, foot care, giving information of stage of DKD and medical examinations.
Results: There was no significant difference in types of diabetes (types 1 and 2; 2/22 vs. 1/23), gender (men/women; 15/9 vs.18/6), duration of diabetes (15 ± 9 vs. 19 ± 11 yrs.), observation period (7.9 ± 1.3 vs. 7.3 ± 2.4 yrs.) between MTA and DA. MTA is significantly younger (57 ± 12 years old) than DA (67 ± 9 years old) (p=0.002). Number of interventions per year were 3.6 ± 1.4 vs. 2.6 ± 1.9 times between MTA and DA (p=0.046). Also the initial eGFR (61.0 ± 26.6 vs. 60.1 ± 19.4 mL/min/1.73m2) and albuminuria levels (246 (33-1923) vs. 382 (35-2008) mg/g•Cr) were comparable between the groups. Annual eGFR decline rate in MTA group (−1.38 ± 2.11 mL/min 1.73m2) was significantly lower than that in DA group (−3.89 ± 6.34). Two subjects were initiated hemodialysis only in the DA group (likelihood ratio 2.86, p=0.091). Four subjects died in only the DA group (likelihood ratio 5.91, p=0.015).
Summary: It is possible that MTA affects the prevention of renal function decline compared with the intervention provided by DA alone. Subjects with DKD, even with normal renal function, may be recommended to have MTA to prevent the progression of renal failure.
M.Hitomi: None. N.Hiki: None. U.Sakamoto: None. Y.Usui: None. T.Miyatsuka: Speaker's Bureau; Eli Lilly Japan K.K., Novo Nordisk, Sanofi K.K., Mitsubishi Tanabe Pharma Corporation, Sumitomo Dainippon Pharma Co., Ltd., Teijin Pharma Limited, Sanwa Kagaku Kenkyusho, Daiichi Sankyo. T.Moriya: None.