Person-Centered Integrated Care for Chronic Kidney Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

• Published in: Clinical journal of the American Society of Nephrology Vol. 13; no. 3; pp. 375 - 386
• Main Authors: Valentijn, Pim P, Pereira, Fernando Abdalla, Ruospo, Marinella, Palmer, Suetonia C, Hegbrant, Jörgen, Sterner, Christina W, Vrijhoef, Hubertus J M, Ruwaard, Dirk, Strippoli, Giovanni F M
• Format: Journal Article
• Language: English
• Published: United States American Society of Nephrology 07.03.2018
• Subjects: Blood Pressure; Cardiovascular Diseases - mortality; Creatinine - blood; Delivery of Health Care, Integrated; Hospitalization; Humans; Mortality; Original; Patient-Centered Care; Quality of Life; Randomized Controlled Trials as Topic; Renal Insufficiency, Chronic - physiopathology; Renal Insufficiency, Chronic - therapy; Renal Replacement Therapy; Patient care management; blood pressure; Confidence Intervals; Renal Insufficiency, Chronic; chronic kidney disease; Follow-Up Studies; collaborative care; hospitalization; comprehensive care; Case management; EGFR protein, human; Renal Replacement Therapy; Risk; Climacteric; randomized controlled trials; systematic review; Care coordination; Managed care programs; creatinine; Integrated care; Patient-centered care; quality of life; Blood Pressure Determination; Receptor, Epidermal Growth Factor
• ISSN: 1555-9041; 1555-905X
• DOI: 10.2215/CJN.09960917

The effectiveness of person-centered integrated care strategies for CKD is uncertain. We conducted a systematic review and meta-analysis of randomized, controlled trials to assess the effect of person-centered integrated care for CKD. We searched MEDLINE, Embase, and Cochrane Central Register of Controlled Trials (from inception to April of 2016), and selected randomized, controlled trials of person-centered integrated care interventions with a minimum follow-up of 3 months. Random-effects meta-analysis was used to assess the effect of person-centered integrated care. We included 14 eligible studies covering 4693 participants with a mean follow-up of 12 months. In moderate quality evidence, person-centered integrated care probably had no effect on all-cause mortality (relative risk [RR], 0.86; 95% confidence interval [95% CI], 0.68 to 1.08) or health-related quality of life (standardized mean difference, 0.02; 95% CI, -0.05 to 0.10). The effects on renal replacement therapy (RRT) (RR, 1.00; 95% CI, 0.65 to 1.55), serum creatinine levels (mean difference, 0.59 mg/dl; 95% CI, -0.38 to 0.36), and eGFR (mean difference, 1.51 ml/min per 1.73 m ; 95% CI, -3.25 to 6.27) were very uncertain. Quantitative analysis suggested that person-centered integrated care interventions may reduce all-cause hospitalization (RR, 0.38; 95% CI, 0.15 to 0.95) and improve BP control (RR, 1.20; 95% CI, 1.00 to 1.44), although the certainty of the evidence was very low. Person-centered integrated care may have little effect on mortality or quality of life. The effects on serum creatinine, eGFR, and RRT are uncertain, although person-centered integrated care may lead to fewer hospitalizations and improved BP control.