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Multidisciplinary Care Clinics (MCC) for people with advanced chronic kidney disease (ACKD) could offer a better option for preparing these patients for dialysis, transplantation or conservative care, but the growing demand to access exceeds the available capacity in these health services. In accordance with the fact that the Kidney Failure Risk Equation (KFRE) would predict the risk of admission to dialysis in patients with ACKD, international nephrology centers have proposed conditioning entry to MCC only to people with KFRE > 10% at 2 years or eGFR <15 ml/min/1.73 m2. Those with KFRE 10% would have a lower risk of entering dialysis and would not require an intensive and comprehensive renal care.
The present study retrospectively evaluated the predictive value that KFRE scored had upon admission of our patients to MCC and the actual requirement for dialysis at 2 years.
Retrospective study of people with ACKD treated for 6 months or more in the MCC of the Hospital Las Higueras Talcahuano, Chile, from August 2016 to December 2022.
According to % KFRE (4 variables) at 2 years recorded upon admission to the MCC, patients were divided into 2 groups: 1) KFRE £ 10%; 2) KFRE > 10%. The evaluated variables were: a) Distribution by age, sex, CKD grade and comorbidities; b) Time in MCC; c) Permanence in MCC without dialysis; d) Admission to chronic dialysis.
400 patients were evaluated, of which 341 had KFRE on admission. Group 1 (n 79; 23.2%), Group 2 (n 262; 76.8%). The analysis of the following variables showed statistically significant differences between both groups (p<0.05): average age 75 (±12) vs 64 (±13) years; women 14.7% vs 36.7%; CKD grades G4 0.9% vs 29% and G5 22.3% vs 47.8%; average time in MCC 39 (±26) vs 21 (±15) months; permanence in MCC without dialysis 83.5% vs 51.5%; admission to chronic dialysis 16.5% vs 48.5%. The comorbidities Diabetes and Coronary Artery Disease had a higher percentage in group 2 (p<0.05). The Hazard Ratio (HR) of people with KFRE>10% have a 2.5 times greater risk of entering dialysis within two years.
Our results show that people with CKD G4 and G5 and KFRE ≤10% have a low risk of progressing and requiring dialysis within 2 years, which agrees with what was reported as an exclusion criterion for admission to the MCC. KFRE would be a valuable prognostic tool that can help physicians identify patients at high risk for dialysis admission, who would require and benefit from receiving intensive renal support and care. Further studies are required to validate what has been reported and to propose models that ensure continuity of care for those patients who eventually leave the MKCC.
We highlight the permanence in MCC of 51.5% of people with high KFRE risk without entering dialysis would require to evaluate the role of multidisciplinary management and its impact on the evolution of the disease.