Taiwan and Japan Researchers Collaborate to Find Protective Effects of Higher Quality of Care on Initiation of Long-term Dialysis in Diabetic Patients With Chronic Kidney Disease
Photo (from left to right): Dr. Hon-Yen Wu, Prof. Shunichi Fukuhara, Prof. Kuo-Liong Chien, and Dr. Shingo Fukuma
In a nationwide cohort study of 63,260 diabetic patients with incident chronic kidney disease (CKD), the CKD-care quality indicators were shown to be useful to study processes and outcomes of CKD care, and higher-quality care provided better renoprotection in these CKD patients. This collaborative study was primarily conducted by Dr. Hon-Yen Wu, a nephrologist in Far Eastern Memorial Hospital and the Adjunct Assistant Professor from the College of Public Health at National Taiwan University, and Dr. Shingo Fukuma, the Associate Professor in School of Public Health at Kyoto University; their work was supervised by Prof. Kuo-Liong Chien from National Taiwan University and Prof. Shunichi Fukuhara from Kyoto University. This study was supported by research grants to Dr. Wu from the National Health Research Institutes of Taiwan, and has been published online on 29 July 2017 in American Journal of Kidney Diseases (http://dx.doi.org/10.1053/j.ajkd.2017.05.020).
“The burden of diabetes-related CKD on individuals and society is increasing, shifting attention toward improving the quality of care for patients with CKD and diabetes.” said Drs. Wu and Fukuma, the equal first authors of the article who have accomplished this study together under the collaborative framework between National Taiwan University and Kyoto University.
The researchers utilized data from the National Health Insurance Research Database of Taiwan to construct this cohort. Three CKD-care quality indicators recently developed by Japan Researchers were measured: prescription of renin-angiotensin system inhibitors, testing for proteinuria, and nutritional guidance. Using instrumental variables to minimize the effects of both unmeasured and measured confounding, the researchers found that higher-quality CKD care protected patients against long-term dialysis therapy and hospitalization due to acute kidney injury. Very few patients received care of the highest quality, and the greatest room for improvement was in nutritional guidance.
"Our findings suggest potential opportunities to improve long-term outcomes among patients with diabetes and CKD by improving the quality of their CKD care." said Drs. Wu and Fukuma, "These results are useful for both physicians and policy makers and can help meet society’s strong need to improve the quality of CKD care."