Multifactorial intervention with nurse practitioners does not change cardiovascular outcomes in patients with chronic kidney disease

• Published in: Kidney international Vol. 82; no. 6; p. 710
• Main Authors: van Zuilen, Arjan D, Bots, Michiel L, Dulger, Arzu, van der Tweel, Ingeborg, van Buren, Marjolijn, Ten Dam, Marc A G J, Kaasjager, Karin A H, Ligtenberg, Gerry, Sijpkens, Yvo W J, Sluiter, Henk E, van de Ven, Peter J G, Vervoort, Gerald, Vleming, Louis-Jean, Blankestijn, Peter J, Wetzels, Jack F M
• Format: Journal Article
• Language: English
• Published: United States 01-09-2012
• Subjects: Aged; Cardiovascular Agents - therapeutic use; Cardiovascular Diseases - blood; Cardiovascular Diseases - mortality; Cardiovascular Diseases - nursing; Cardiovascular Diseases - physiopathology; Cardiovascular Diseases - prevention & control; Combined Modality Therapy; Disease Progression; Female; Glomerular Filtration Rate; Guideline Adherence; Humans; Kidney - physiopathology; Kidney Failure, Chronic - mortality; Kidney Failure, Chronic - nursing; Kidney Failure, Chronic - prevention & control; Linear Models; Male; Middle Aged; Motor Activity; Myocardial Infarction - mortality; Myocardial Infarction - nursing; Myocardial Infarction - prevention & control; Netherlands; Nurse Practitioners; Practice Guidelines as Topic; Preventive Health Services; Proportional Hazards Models; Renal Insufficiency, Chronic - blood; Renal Insufficiency, Chronic - diagnosis; Renal Insufficiency, Chronic - mortality; Renal Insufficiency, Chronic - nursing; Renal Insufficiency, Chronic - physiopathology; Renal Insufficiency, Chronic - therapy; Risk Assessment; Risk Factors; Risk Reduction Behavior; Severity of Illness Index; Smoking Cessation; Stroke - mortality; Stroke - nursing; Stroke - prevention & control; Time Factors; Treatment Outcome; Weight Loss; Netherlands
• ISSN: 1523-1755
• DOI: 10.1038/ki.2012.137

Strict implementation of guidelines directed at multiple targets reduces vascular risk in diabetic patients. Whether this also applies to patients with chronic kidney disease (CKD) is uncertain. To evaluate this, the MASTERPLAN Study randomized 788 patients with CKD (estimated GFR 20-70 ml/min) to receive additional intensive nurse practitioner support (the intervention group) or nephrologist care (the control group). The primary end point was a composite of myocardial infarction, stroke, or cardiovascular death. During a mean follow-up of 4.62 years, modest but significant decreases were found for blood pressure, LDL cholesterol, anemia, proteinuria along with the increased use of active vitamin D or analogs, aspirin and statins in the intervention group compared to the controls. No differences were found in the rate of smoking cessation, weight reduction, sodium excretion, physical activity, or glycemic control. Intensive control did not reduce the rate of the composite end point (21.3/1000 person-years in the intervention group compared to 23.8/1000 person-years in the controls (hazard ratio 0.90)). No differences were found in the secondary outcomes of vascular interventions, all-cause mortality or end-stage renal disease. Thus, the addition of intensive support by nurse practitioner care in patients with CKD improved some risk factor levels, but did not significantly reduce the rate of the primary or secondary end points.