Thanamayooran S et al. (2005) Effectiveness of a multidisciplinary kidney disease clinic in achieving treatment guideline targets. Nephrol Dial Transplant 20: 2385–2393

Multidisciplinary kidney disease clinics—incorporating a range of specialists such as dietitians and nurse educators—have been recommended for the management of patients with chronic kidney disease. A recent Canadian study has assessed the effectiveness of this approach, with a particular focus on blood pressure and metabolic control, medication, and preparation for dialysis.

Thanamayooran and colleagues carried out a 4-year follow-up of a cohort of chronic kidney disease patients (n = 340 at study start, dropping to 70 at 4-year follow-up; mean age 67 years), who had been referred to their nephrology clinic. In a previous study, the authors reported that several aspects of this same cohort's care had been below standard at referral.

Although improvements were noted following referral, results indicated that the patients' management failed to reach the recommended standard in many cases. For example, an overall improvement in phosphate control was recorded during follow-up, but more than a quarter of patients with a creatinine clearance of less than 0.5 ml/s had hyperphosphatemia. Similarly, blood pressure control improved in the group as a whole, but 62% of patients failed to achieve blood pressure levels below 130 mm Hg systolic or 85 mm Hg diastolic throughout follow-up.

The authors suggest that benchmarks are now needed for chronic kidney disease management, to help define the optimum level of care.