Multidisciplinary care in patients with chronic kidney disease: A systematic review and meta-analysis

• We reviewed current evidence of multidisciplinary care in patients with chronic kidney disease.
• Professionals vary among studies of multidisciplinary care.
• Limited evidences are currently available for the benefits of multidisciplinary care.
• The survival benefit was mainly obtained from observational cohort studies.

BackgroundMultidisciplinary care (MDC) was widely used in multiple chronic illnesses but the effectiveness of MDC in patients with chronic kidney disease (CKD) was inconclusive. The aim of this meta-analysis is to estimate the effectiveness of MDC for CKD.MethodsWe searched PubMed, Web of Science, Google Scholar, Cochrane Library, and China Journal Full-text Database for relevant articles published in English or Chinese. Studies investigating MDC and non-MDC in patients with CKD were included. Random effect model was used to compare all-cause mortality, dialysis, risk of temporal catheterization, and hospitalization in the two treatment entities.ResultsWe analyzed 8853 patients of 18 studies in patients with CKD stages 3–5, aged 63 ± 12 years. MDC was associated with lower risk of all-cause mortality with an odds ratio (OR) of 0.52 [95% confidence interval (CI): 0.44–0.88, p = 0.01], mainly in cohort studies. MDC was associated with a lower risk of starting dialysis (p = 0.02) and lower risk of temporal catheterization for dialysis (p < 0.01). MDC was not associated with a higher chance of choosing peritoneal dialysis (p = 0.18) or a lower chance of hospitalization for dialysis (p = 0.13).ConclusionsLimited evidence from randomized controlled trials is currently available to support the benefit of MDC in patients with CKD. MDC is associated with lower all-cause mortality, lower risk of starting dialysis, and lower risk of temporal catheterization for dialysis in cohort studies. MDC is not associated with a higher chance of choosing peritoneal dialysis or a lower chance of hospitalization for dialysis. More studies are needed to determine the optimal professional that should be included in MDC.