Effects of renal care coordinator case management on outcomes in incident dialysis patients

Background: Pre-dialysis chronic kidney disease (CKD) care impacts dialysis start and incident dialysis outcomes. We describe the use of late stage CKD population data coupled with CKD case management to improve dialysis start. Methods: The Renal Care Coordinator (RCC) program is a nephrology practice and Fresenius Medical Care North America (FMCNA) partnership involving a case manager resource and data analytics. We studied patients starting dialysis between August 1, 2009 and February 28, 2013 in 9 nephrology practices partnering in the RCC program. Propensity score matching (PSM) was used to match patients who had participated in the RCC program to patients who had not. Primary outcomes were use of a permanent access or peritoneal dialysis (PD) at first outpatient dialysis. Serum albumin at the first outpatient dialysis treatment and mortality and hospitalization rates in the first 120 days of dialysis were secondary outcomes. Results: In the nephrology practices studied, 7,626 patients started dialysis. Of these, 738 patients (9.7%) were enrolled in the RCC program; 693 RCC patients (93.9%) were matched with 693 patients who did not participate in the RCC program. Logistic regression analysis indicates that RCC program patients are more likely to start PD or use a permanent vascular access at dialysis start and are more likely to start treatment with a serum albumin level >= 4.0 g/dL. Conclusion: Late stage CKD data-driven case management is associated with a higher rate of PD use, lower central venous catheter (CVC) use, and higher albumin levels at first outpatient dialysis.