How long does the kidney protective effects of inpatient educational program last? A 5-year extended follow-up study

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How long does the kidney protective effects of inpatient educational program last? A 5-year extended follow-up study

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Co-author 1

Yoko Kusumoto ykksmt8719@outlook.com St. Marianna University School of Medicine Division of Nephrology and Hypertension, Department of Internal Medicine Kanagawa Japan *

Co-author 2

Wei Han Takagi wei.han@marianna-u.ac.jp St. Marianna University School of Medicine Division of Nephrology and Hypertension, Department of Internal Medicine Kanagawa Japan -

Co-author 3

Yugo Shibagaki yugoshibagaki@gmail.com St. Marianna University School of Medicine Division of Nephrology and Hypertension, Department of Internal Medicine Kanagawa Japan -

Co-author 4

Tomoya Nishino tnishino@nagasaki-u.ac.jp Nagasaki University Hospital Department of Nephrology Nagasaki Japan -

Co-author 5

Tsutomu Sakurada sakurada@marianna-u.ac.jp St. Marianna University School of Medicine Division of Nephrology and Hypertension, Department of Internal Medicine Kanagawa Japan -

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Introduction

Although several reports have shown the kidney protective effects of inpatient educational programs (IEPs) for patients with chronic kidney disease (CKD), their effectiveness has only been demonstrated up to 2 years after intervention. The purpose of this study was to clarify the kidney protective effects of IEPs up to 5 years after intervention.

Methods

A total of 311 CKD patients (mean age 70.1±12.3 years, 68.8% male) who underwent an IEP at our hospital between January 1, 2011 and August 31, 2021 were included. The annual changes in the estimated glomerular filtration rate (ΔeGFR) with 1 year before the start of the IEP as the baseline and urinary protein (g/gCr) with the start of the IEP compared at 1, 2, 3, 4, and 5 years after the start of the IEP using Tukey's honestly significant difference test. Multivariate Cox proportional hazards regression analysis was used to identify independent predictors of the composite outcome of renal replacement therapy initiation and death.

Results

The mean ΔeGFR was –5.11±7.66 mL/min/1.73m2/year before IEP. ΔeGFR was significantly less at 1, 2, and 4 years after the start of the IEP (-0.87±6.11, -0.33±3.99, and -1.18±3.97 mL/min/1.73m2/year, respectively, all P<0.05). Although ΔeGFR tended to be less 3 and 5 years after the start of the IEP (-2.22±3.70 and -2.90±4.86 mL/min/1.73m2/year, respectively), there were no significant differences. In addition, ΔeGFR tended to gradually worsen from 3 years after IEP. Urinary protein showed a decreasing trend up to 2 years later, but it then began to increase. Male sex and hemoglobin, eGFR, and urinary protein levels at baseline were identified as independent predictors of the composite outcome.

Conclusion

The kidney protective effects of IEPs are not permanent and weakened over time. Therefore, additional educational interventions may be necessary for CKD patients undergoing IEPs.

Kewords