Effect of continuous quality improvement on renal function in patients with chronic kidney disease of stage 3-4 / 第二军医大学学报

ABSTRACT

Objective To establish a management mode for patients with chronic kidney disease (CKD) of stage 3 to 4 by continuous quality improvement (CQI), and to observe the effect of CQI on renal function in CKD patients. Methods A total of 86 patients with CKD (50 in stage 3 and 36 in stage 4) were enrolled in this study, and they were regularly followed-up in the CKD outpatient of the Department of Nephrology of Jing’an District Zhabei Centre Hospital of Shanghai. The patients were randomly divided into observation group and control group, with 43 cases in each group. In the observation group, we used the management mode combining medical intervention and health education by plan-do-check-act (PDCA) four-step method; in the control group, we used the traditional management mode of medical intervention. All the patients were followed up once a month for one year. The end points included doubling serum creatinine (Scr) or entering end-stage renal disease, and occurence of cardiovascular and cerebrovascular events. The follow-up on time rate (%), Scr level, and estimated glomerular filtration rate (eGFR) were compared between the two groups. Results In the observation group, the average follow-up times were 10.7±2.8 and the follow-up on time rate was (89.9±12.8)%; while those were 4.1±2.2 and (34.2±4.9)% in the control group, and there were significant differences between the two groups (all P0.01). During the 1-year follow-up period, two cases had end-stage renal disease and one case had acute angina in the control group, while no end point was found in the observation group. Before the implementation of CQI, there were no significant differences in eGFR or Scr level between the two groups (all P0.05). The eGFR of the observation group after implementation of CQI was (39.35±12.23) mL/(min • 1.73 m2), which was significantly higher than those of the observation group before implementation ([37.22±11.02] mL/[min • 1.73 m2], P0.05) and the control group after implementation ([35.04±12.31] mL/[min • 1.73 m2], P0.05). The Scr level of the observation group after implementation of CQI was (139.25±14.15) µmol/L, which was significantly lower than those of the observation group before implementation ([145.16±15.41] µmol/L, P0.05) and the control group after the implementation ([148.06±15.63] µmol/L, P0.05). Conclusion CQI management method with the combination of medical intervention and health education can improve the renal function of patients with CKD stages 3-4, and reduce the incidence of end-stage renal disease and cardiovascular and cerevascular events.