Nurse Practitioner Care Improves Renal Outcome in Patients with CKD

Treatment goals for patients with CKD are often unrealized for many reasons, but support by nurse practitioners may improve risk factor levels in these patients. Here, we analyzed renal endpoints of the Multifactorial Approach and Superior Treatment Efficacy in Renal Patients with the Aid of Nurse P...

Full description

Saved in:
Bibliographic Details
Published in:Journal of the American Society of Nephrology Vol. 25; no. 2; pp. 390 - 398
Main Authors: PEETERS, Mieke J, VAN ZUILEN, Arjan D, VAN DE VEN, Peter J. G, VERVOORT, Gerald, VLEMING, Louis-Jean, BLANKESTIJN, Peter J, WETZELS, Jack F. M, VAN DEN BRAND, Jan A. J. G, BOTS, Michiel L, VAN BUREN, Marjolijn, TEN DAM, Marc A. G. J, KAASJAGER, Karin A. H, LIGTENBERG, Gerry, SIJPKENS, Yvo W. J, SLUITER, Henk E
Format: Journal Article
Language:English
Published: Washington, DC American Society of Nephrology 01-02-2014
Subjects:
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Treatment goals for patients with CKD are often unrealized for many reasons, but support by nurse practitioners may improve risk factor levels in these patients. Here, we analyzed renal endpoints of the Multifactorial Approach and Superior Treatment Efficacy in Renal Patients with the Aid of Nurse Practitioners (MASTERPLAN) study after extended follow-up to determine whether strict implementation of current CKD guidelines through the aid of nurse practitioners improves renal outcome. In total, 788 patients with moderate to severe CKD were randomized to receive nurse practitioner support added to physician care (intervention group) or physician care alone (control group). Median follow-up was 5.7 years. Renal outcome was a secondary endpoint of the MASTERPLAN study. We used a composite renal endpoint of death, ESRD, and 50% increase in serum creatinine. Event rates were compared with adjustment for baseline serum creatinine concentration and changes in estimated GFR were determined. During the randomized phase, there were small but significant differences between the groups in BP, proteinuria, LDL cholesterol, and use of aspirin, statins, active vitamin D, and antihypertensive medications, in favor of the intervention group. The intervention reduced the incidence of the composite renal endpoint by 20% (hazard ratio, 0.80; 95% confidence interval, 0.66 to 0.98; P=0.03). In the intervention group, the decrease in estimated GFR was 0.45 ml/min per 1.73 m(2) per year less than in the control group (P=0.01). In conclusion, additional support by nurse practitioners attenuated the decline of kidney function and improved renal outcome in patients with CKD.
Bibliography:ObjectType-Article-2
SourceType-Scholarly Journals-1
ObjectType-News-1
ObjectType-Feature-3
content type line 23
ISSN:1046-6673
1533-3450
DOI:10.1681/ASN.2012121222