Effectiveness of Quality Improvement Strategies for the Management of CKD: A Meta-Analysis
- PMID: 28877926
- PMCID: PMC5628709
- DOI: 10.2215/CJN.02490317
Effectiveness of Quality Improvement Strategies for the Management of CKD: A Meta-Analysis
Abstract
Background and objectives: Quality improvement interventions have enhanced care for other chronic illnesses, but their effectiveness for patients with CKD is unknown. We sought to determine the effects of quality improvement strategies on clinical outcomes in adult patients with nondialysis-requiring CKD.
Design, setting, participants, & measurements: We conducted a systematic review of randomized trials, searching Medline and the Cochrane Effective Practice and Organization of Care database from January of 2003 to April of 2015. Eligible studies evaluated one or more of 11 prespecified quality improvement strategies, and prespecified study outcomes included at least one process of care measure, surrogate outcome, or hard clinical outcome. We used a random effects model to estimate the pooled risk ratio (RR; dichotomous data) or the mean difference (continuous data).
Results: We reviewed 15 patient-level randomized trials (n=3298 patients), and six cluster-randomized trials (n=30,042 patients). Quality improvement strategies reduced dialysis incidence (seven trials; RR, 0.85; 95% confidence interval [95% CI], 0.74 to 0.97) and LDL cholesterol concentrations (four trials; mean difference, -17.6 mg/dl; 95% CI, -28.7 to -6.5), and increased the likelihood that patients received renin-angiotensin-aldosterone system inhibitors (nine trials; RR, 1.16; 95% CI, 1.06 to 1.27). We did not observe statistically significant effects on mortality, cardiovascular events, eGFR, glycated hemoglobin, and systolic or diastolic BP.
Conclusions: Quality improvement interventions yielded significant beneficial effects on three elements of CKD care. Estimates of the effectiveness of quality improvement strategies were limited by study number and adherence to quality improvement principles.
Podcast: This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2017_09_06_CJASNPodcast_17_10.mp3.
Keywords: Adult; Cholesterol, LDL; Chronic Disease; Confidence Intervals; Disease Management; Hemoglobin A, Glycosylated; Humans; Incidence; Odds Ratio; Probability; Quality Improvement; Randomized Controlled Trials as Topic; Renal Insufficiency, Chronic; Renin-Angiotensin System; Risk; blood pressure; chronic kidney disease; chronic kidney failure; glomerular filtration rate; quality improvement; renal dialysis.
Copyright © 2017 by the American Society of Nephrology.
Figures
Similar articles
-
Folic acid supplementation and malaria susceptibility and severity among people taking antifolate antimalarial drugs in endemic areas.Cochrane Database Syst Rev. 2022 Feb 1;2(2022):CD014217. doi: 10.1002/14651858.CD014217. Cochrane Database Syst Rev. 2022. PMID: 36321557 Free PMC article.
-
Early referral strategies for management of people with markers of renal disease: a systematic review of the evidence of clinical effectiveness, cost-effectiveness and economic analysis.Health Technol Assess. 2010 Apr;14(21):1-184. doi: 10.3310/hta14210. Health Technol Assess. 2010. PMID: 20441712 Review.
-
Interventions for weight loss in people with chronic kidney disease who are overweight or obese.Cochrane Database Syst Rev. 2021 Mar 30;3(3):CD013119. doi: 10.1002/14651858.CD013119.pub2. Cochrane Database Syst Rev. 2021. PMID: 33782940 Free PMC article.
-
Pragmatic Randomized, Controlled Trial of Patient Navigators and Enhanced Personal Health Records in CKD.Clin J Am Soc Nephrol. 2017 Sep 7;12(9):1418-1427. doi: 10.2215/CJN.02100217. Epub 2017 Aug 4. Clin J Am Soc Nephrol. 2017. PMID: 28778854 Free PMC article. Clinical Trial.
-
Sevelamer Versus Calcium-Based Binders for Treatment of Hyperphosphatemia in CKD: A Meta-Analysis of Randomized Controlled Trials.Clin J Am Soc Nephrol. 2016 Feb 5;11(2):232-44. doi: 10.2215/CJN.06800615. Epub 2015 Dec 14. Clin J Am Soc Nephrol. 2016. PMID: 26668024 Free PMC article. Review.
Cited by
-
What does the French REIN registry tell us about Stage 4-5 CKD care in older adults?Front Nephrol. 2023 Jan 17;2:1026874. doi: 10.3389/fneph.2022.1026874. eCollection 2022. Front Nephrol. 2023. PMID: 37675001 Free PMC article. Review.
-
The first appointment with a nephrologist: Brazilian patients' demographic and kidney function characteristics. A retrospective study.Sao Paulo Med J. 2022 May-Jun;140(3):366-371. doi: 10.1590/1516-3180.2021.0194.R1.13082021. Sao Paulo Med J. 2022. PMID: 35508000 Free PMC article.
-
Characteristics and Effectiveness of Dedicated Care Programs for Patients Starting Dialysis: A Systematic Review.Kidney360. 2020 Sep 8;1(11):1244-1253. doi: 10.34067/KID.0004052020. eCollection 2020 Nov 25. Kidney360. 2020. PMID: 35372876 Free PMC article.
-
Quality Improvement in Canadian Nephrology: Key Considerations in Ensuring Thoughtful Ethical Oversight.Can J Kidney Health Dis. 2022 Feb 27;9:20543581221077504. doi: 10.1177/20543581221077504. eCollection 2022. Can J Kidney Health Dis. 2022. PMID: 35251671 Free PMC article.
-
Neighborhood Socioeconomic Status and Quality of Kidney Care: Data From Electronic Health Records.Kidney Med. 2021 Apr 19;3(4):515-527.e1. doi: 10.1016/j.xkme.2021.02.008. eCollection 2021 Jul-Aug. Kidney Med. 2021. PMID: 34401719 Free PMC article.
References
-
- Coresh J, Selvin E, Stevens LA, Manzi J, Kusek JW, Eggers P, Van Lente F, Levey AS: Prevalence of chronic kidney disease in the United States. JAMA 298: 2038–2047, 2007 - PubMed
-
- Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group : KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl 3: 1–150, 2013
-
- Philipneri MD, Rocca Rey LA, Schnitzler MA, Abbott KC, Brennan DC, Takemoto SK, Buchanan PM, Burroughs TE, Willoughby LM, Lentine KL: Delivery patterns of recommended chronic kidney disease care in clinical practice: Administrative claims-based analysis and systematic literature review. Clin Exp Nephrol 12: 41–52, 2008 - PubMed
Publication types
MeSH terms
Substances
Grants and funding
LinkOut - more resources
Full Text Sources
Other Literature Sources
Medical
Research Materials
Miscellaneous