A multidisciplinary intervention to improve care for professionals and patients against ACKD

On World Kidney Day (March 9) we become aware of Advanced Chronic Kidney Disease. From the MARCEVAP of the IDIAP Jordi Gol ja they are working on the design and evaluation of a multidisciplinary comprehensive care program in Advanced Chronic Kidney Disease (ACKD).

The project will go through three phases (design, implementation and evaluation) and will end in the last semester of 2024.

A new multidisciplinary intervention that affects the management and treatment of Advanced Chronic Kidney Disease (ACKD) that, in the long run, reduces the complications associated with the disease and the eventual need for replacement treatment, through dialysis or kidney transplantation. This is the intention behind the new project that the MARCEVAP of the IDIAP Jordi Gol has started, with the direction of Iris Lumillo as Principal Investigator.

 ACKD Considerations

Chronic Kidney Disease is the alteration of the functioning of the kidneys that cannot filter the blood properly. In later stages, this damage can cause waste products to build up in the body and cause other health problems. Advanced chronic kidney disease (MRCA) is associated with an increased risk of cardiovascular events or progression of kidney disease requiring replacement therapy (kidney transplant or dialysis).

To treat this disease, it is necessary to try to reduce or avoid the progression of ACKD and the resulting complications. In Catalonia, 8% of those over 60 with CKD have advanced stages. In addition to affecting the quality of life, healthcare to treat these patients is becoming more and more expensive. However, primary care is a fundamental pillar in the management of risk factors for disease progression, from the initial stages to advanced phases, especially in cases that do not receive renal replacement therapy. But today, Primary Care professionals have few tools to be able to meet this objective and care for patients well.

Therefore, this multidisciplinary intervention becomes more necessary. It should be noted that chronic disease care programs made up of multidisciplinary teams, and based on standardized action guides, have been associated with lower care costs, better hospitalization and mortality rates. Thus, through a good design of this intervention in which the different teams act in a coordinated manner, it will be possible to implement this new comprehensive care treatment that improves the results of ACKD.

Multidisciplinary intervention work plan

The work plan consists of two phases: analysis of the baseline situation, design and implementation, in the first; evaluation, in the second. Baseline analysis combines two approaches. The first, quantitative, will identify people diagnosed with ACKD through electronic records to find out the current management of the disease; the second, qualitative, aims to describe those barriers and facilitators that professionals perceive for caring for located people. All these analyzed data will allow the multidisciplinary team to adapt the intervention. In the intervention phase, professionals will have access to new digital support tools and training in ACKD. The intervention will begin during the second year and in the last semester of 2024, evaluating its impact by comparing data between centers that have applied the new intervention and centers that have not.

In this project, it is expected to identify an important group of people affected by ACKD who can benefit from this treatment based on structured comprehensive care. With the improvement that this multidisciplinary intervention in the management and control of the disease will entail, it is expected to reduce admissions for cardiovascular causes and the need for replacement treatment by kidney transplant or dialysis.

MARCEVAP, a new IDIAP research group Jordi Gol

Illness, cardiovascular risk and lifestyle in primary care (MARCEVAP) is a multidisciplinary research group in primary care, accredited by the Agència de Gestió d'Ajudes Universitàries i d'Investigació (AGAUR). The group combines professionals with a care profile with others with a more methodological profile with the aim of seeking answers and improvements in care for people with kidney disease and other chronic pathologies that have associated cardiovascular risk. The coordinator of the group is Dr. Belén Salvador, although in this project Dr. Iris Lumillo, PhD in Nursing Sciences, commands the entire intervention.