ABSTRACT
Purpose: To examine the effect of integrated follow-up (a nephrologist, nurse and dietician) in patients with chronic kidney disease (CKD).
Method: A total of 1,500 CKD patients enrolled from the out-patient department of West China Hospital were randomly allocated to the integrated follow-up group (n=750) and the traditional follow-up group (n=750). Patients were followed up for 1 year. The outcome indexes in the study included the main lab indexes, compliance to follow-up, quality of life, and patient satisfaction.
Results: Scores on compliance and patient satisfaction in integrated follow-up group was significantly higher than those in traditional follow-up group. The blood pressure control in integrated follow-up group was better compared to those in traditional follow-up group. In addition, although renal function decreased in both group during follow up, eGFR in integrated group was significantly higher.
Conclusion: Integrated follow-up is beneficial to improving patient compliance and satisfaction, controlling blood pressure and slowing down the progress of CKD. The findings in the study pointed out a new model for CKD management.
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