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

Pim P Valentijn, Fernando Abdalla Pereira, Marinella Ruospo, Suetonia C Palmer, Jörgen Hegbrant, Christina W Sterner, Hubertus J M Vrijhoef, Dirk Ruwaard, Giovanni F M Strippoli

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Abstract

BACKGROUND AND OBJECTIVES: 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.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: 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.

RESULTS: 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 m2; 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.

CONCLUSIONS: 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.

Original languageEnglish
Pages (from-to)375-386
Number of pages12
JournalClinical journal of the American Society of Nephrology
Volume13
Issue number3
DOIs
Publication statusPublished - 7 Mar 2018

Keywords

  • Integrated care
  • randomized controlled trials
  • systematic review
  • Patient-centered care
  • Care coordination
  • Managed care programs
  • Patient care management
  • collaborative care
  • comprehensive care
  • Case management
  • Risk
  • creatinine
  • Confidence Intervals
  • blood pressure
  • quality of life
  • Follow-Up Studies
  • Climacteric
  • Renal Insufficiency
  • Chronic
  • Blood Pressure Determination
  • EGFR protein
  • human
  • Receptor
  • Epidermal Growth Factor
  • chronic kidney disease
  • Renal Replacement Therapy
  • hospitalization
  • QUALITY-OF-LIFE
  • MANAGEMENT PROGRAMS
  • MULTIDISCIPLINARY CARE
  • HEART-FAILURE
  • PERITONEAL-DIALYSIS
  • DEPRESSION
  • MODEL
  • PATIENT
  • IMPACT
  • HETEROGENEITY

Cite this

Valentijn, P. P., Pereira, F. A., Ruospo, M., Palmer, S. C., Hegbrant, J., Sterner, C. W., Vrijhoef, H. J. M., Ruwaard, D., & Strippoli, G. F. M. (2018). Person-Centered Integrated Care for Chronic Kidney Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Clinical journal of the American Society of Nephrology, 13(3), 375-386. https://doi.org/10.2215/CJN.09960917