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Implémentation des trajets de soins de l'insuffisance rénale chronique : Bénéfices pour le patient et perspectives en termes de santé publique

par Ben Omar Bridi, Salwa ;Plennevaux, Veronique ;Racapé, Judith ;Nortier, Joëlle
Référence Revue médicale de Bruxelles, 37, 1, page (5-12)
Publication Publié, 2016-02

Article révisé par les pairs

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Résumé :

Because of the significant costs related to the treatment of end-stage kidney disease by dialysis, Belgian Health Care Authorities proposed in June 2009 an early multidisciplinary care of the chronic kidney disease (CKD) in a so-called clinical pathway (CP). Working on the hypothesis that inclusion into a CP could result in reduced morbidity and mortality and delayed admission on dialysis, we initiated a retrospective cohort study on dialyzed patients for whom a prior CKD diagnosis was made between June 1, 2009 and August 31, 2013 in the Nephrology Dept of Erasme Hospital. The exposed patient group was defined as enrolled patients into a CP (n = 25), the control patients were free of any CP (n = 25). Survival analyses were performed to search for an association between the inclusion into a CP and the time period needed to reach dialysis, but also to find a possible impact of CP on mortality and risk of hospitalization. The present study showed that CKD-CP significantly delayed the time of dialysis initiation (HR = 0,48 [0,27 - 0,87] p = 0,015) but also reduced mortality (HR = 0,10 [0,02 - 0,53] p = 0,007) and hospitalization risk (HR = 030 [0,11 - 0,83]p = 0,020) after starting dialysis. These data suggest the benefit of a multidisciplinary care of CKD patients. However, a larger scale study is necessary to confirm these results.