Association between primary care physician-nephrologist collaboration and clinical outcomes in patients with stage 5 chronic kidney disease: a JOINT-KD cohort study.

IF 2.7 4区 医学 Q2 UROLOGY & NEPHROLOGY
Minoru Murakami, Takuya Aoki, Yoshifumi Sugiyama, Sho Sasaki, Hiroki Nishiwaki, Masahiko Yazawa, Yoshihiko Raita, Hiroo Kawarazaki, Hideaki Shimizu, Yoshihiro Nakamura, Yosuke Saka, Masato Matsushima
{"title":"Association between primary care physician-nephrologist collaboration and clinical outcomes in patients with stage 5 chronic kidney disease: a JOINT-KD cohort study.","authors":"Minoru Murakami, Takuya Aoki, Yoshifumi Sugiyama, Sho Sasaki, Hiroki Nishiwaki, Masahiko Yazawa, Yoshihiko Raita, Hiroo Kawarazaki, Hideaki Shimizu, Yoshihiro Nakamura, Yosuke Saka, Masato Matsushima","doi":"10.1007/s40620-025-02299-1","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Primary care physician-nephrologist collaboration plays an important role in the management of chronic kidney disease (CKD). However, the benefits of such collaboration in patients with stage 5 CKD remain unclear.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of adult outpatients with stage 5 CKD across nine nephrology centers in Japan. The exposure of interest was primary care physician-nephrologist collaboration. We examined the association between primary care physician-nephrologist collaboration and clinical outcomes in adult outpatients with stage 5 CKD: dialysis initiation and cause-specific hospitalizations using the Fine-Gray models, which treat death and preemptive kidney transplantation and death and kidney replacement therapy as competing risk events, respectively.</p><p><strong>Results: </strong>Of the 570 patients included in the analysis, 91 (16.0%) received primary care physician-nephrologist collaboration, whereas the remaining patients were treated by nephrologists alone. During a median follow-up of 1.4 years, 399 (70.0%) patients started dialysis, 11 (1.9%) received preemptive kidney transplantation, and 53 (9.3%) died. There were no significant between-group differences in dialysis initiation and CKD- and cardiovascular-related hospitalizations (adjusted subdistribution hazard ratio [SHR] [95% confidence interval], 0.89 [0.64-1.23], 1.22 [0.78-1.90], and 0.95 [0.46-1.98], respectively). However, primary care physician-nephrologist collaboration was associated with a lower risk of infection-related hospitalization (adjusted SHR [95% confidence interval], 0.36 [0.15-0.87]).</p><p><strong>Conclusions: </strong>Our findings suggest that primary care physician-nephrologist collaboration in the management of stage 5 CKD is not associated with delayed dialysis initiation but is associated with a lower risk of infection-related hospitalization, indicating the potential benefits of primary care physician-nephrologist collaboration in stage 5 CKD.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.7000,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Nephrology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s40620-025-02299-1","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}
引用次数: 0

Abstract

Background: Primary care physician-nephrologist collaboration plays an important role in the management of chronic kidney disease (CKD). However, the benefits of such collaboration in patients with stage 5 CKD remain unclear.

Methods: We conducted a retrospective cohort study of adult outpatients with stage 5 CKD across nine nephrology centers in Japan. The exposure of interest was primary care physician-nephrologist collaboration. We examined the association between primary care physician-nephrologist collaboration and clinical outcomes in adult outpatients with stage 5 CKD: dialysis initiation and cause-specific hospitalizations using the Fine-Gray models, which treat death and preemptive kidney transplantation and death and kidney replacement therapy as competing risk events, respectively.

Results: Of the 570 patients included in the analysis, 91 (16.0%) received primary care physician-nephrologist collaboration, whereas the remaining patients were treated by nephrologists alone. During a median follow-up of 1.4 years, 399 (70.0%) patients started dialysis, 11 (1.9%) received preemptive kidney transplantation, and 53 (9.3%) died. There were no significant between-group differences in dialysis initiation and CKD- and cardiovascular-related hospitalizations (adjusted subdistribution hazard ratio [SHR] [95% confidence interval], 0.89 [0.64-1.23], 1.22 [0.78-1.90], and 0.95 [0.46-1.98], respectively). However, primary care physician-nephrologist collaboration was associated with a lower risk of infection-related hospitalization (adjusted SHR [95% confidence interval], 0.36 [0.15-0.87]).

Conclusions: Our findings suggest that primary care physician-nephrologist collaboration in the management of stage 5 CKD is not associated with delayed dialysis initiation but is associated with a lower risk of infection-related hospitalization, indicating the potential benefits of primary care physician-nephrologist collaboration in stage 5 CKD.

一项JOINT-KD队列研究:初级保健医师-肾病专家合作与5期慢性肾病患者临床结局之间的关系
背景:初级保健医师与肾病专家的合作在慢性肾脏疾病(CKD)的治疗中起着重要作用。然而,这种合作对5期CKD患者的益处尚不清楚。方法:我们对日本9个肾脏学中心的成人5期CKD门诊患者进行了回顾性队列研究。感兴趣的暴露是初级保健医师与肾病专家的合作。我们使用Fine-Gray模型研究了初级保健医生-肾病专家合作与成人5期CKD门诊患者临床结果之间的关系:透析起始和原因特异性住院,分别将死亡和先发制人的肾移植以及死亡和肾脏替代治疗视为竞争风险事件。结果:在纳入分析的570例患者中,91例(16.0%)接受了初级保健医师-肾病专家合作治疗,而其余患者则由肾病专家单独治疗。在中位随访1.4年期间,399例(70.0%)患者开始透析,11例(1.9%)患者接受了先发制人的肾移植,53例(9.3%)患者死亡。在透析起始和CKD及心血管相关住院方面,组间无显著差异(校正亚分布风险比[SHR][95%置信区间],分别为0.89[0.64-1.23]、1.22[0.78-1.90]和0.95[0.46-1.98])。然而,初级保健医师与肾病专家的合作与感染相关住院的较低风险相关(调整后SHR[95%置信区间],0.36[0.15-0.87])。结论:我们的研究结果表明,初级保健医师-肾脏科医师合作管理5期CKD与延迟透析开始无关,但与感染相关住院的风险较低相关,表明初级保健医师-肾脏科医师合作治疗5期CKD的潜在益处。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
Journal of Nephrology
Journal of Nephrology 医学-泌尿学与肾脏学
CiteScore
5.60
自引率
5.90%
发文量
289
审稿时长
3-8 weeks
期刊介绍: Journal of Nephrology is a bimonthly journal that considers publication of peer reviewed original manuscripts dealing with both clinical and laboratory investigations of relevance to the broad fields of Nephrology, Dialysis and Transplantation. It is the Official Journal of the Italian Society of Nephrology (SIN).
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信