미네랄 골질환 합병증을 가진 투석환자에서 다학제 팀 서비스의 임상적 성과

• Published in: 한국임상약학회지 Vol. 26; no. 4; pp. 318 - 323
• Main Authors: 한나영, 이상민, 홍진이, 노혜진, 지은희, 송윤경, 송지윤, 김인화, 김연수, 오정미, Han, Nayoung, Lee, Sang-Min, Hong, Jin Yi, Noh, Hye Jin, Ji, Eunhee, Song, Yun-Kyoung, Song, Jeeyoun, Kim, In-Wha, Kim, Yon Su, Oh, Jung Mi
• Format: Journal Article
• Language: Korean
• Published: 한국임상약학회 31.12.2016
• Subjects: 약학; chronic kidney disease; clinical outcome; Multidisciplinary team care; mineral and bone disorder; clinical pharmacist
• ISSN: 1226-6051; 2508-786X

Background: Multidisciplinary team care (MTC) is a collaborative approach to treatment plan and ongoing care. We aimed to evaluate the clinical effect of MTC on the regulation of chronic kidney disease-mineral and bone disorder (CKD-MBD) complications in dialysis patients. Methods: This retrospective observational study was approved by the institutional review board. Among patients who have undergone dialysis at admission, the patients admitted to the nephrology ward were allocated to MTC group, and the others to usual care (UC) group. The MTC group had collaborative care by nephrologists, nurses, pharmacists, and nutritionists. The endpoints were the regulation of corrected calcium (cCa) and phosphate (P), the percent of patients in target level of cCa-P product ($cCa{\times}P$), and the prescription rate of non-calcium based P-binders. Results: A total of 163 patients were included from January to December 2009. A significant difference was shown in the percentage of patients in target $cCa{\times}P$ level at admission (MTC vs. UC, 81.40% vs. 91.67%; P = 0.038), but there was no significant difference at discharge. During admission, the cCa and P levels of patients in only UC group were significantly changed. In addition, compared with UC group, patients in MTC group were more likely prescribed appropriate P-binders, when they had higher $cCa{\times}P$ levels than $55mg^2/dL^2$ (P <0.001). Conclusion: It was found that MTC had beneficial effect on improving the regulation of CKD-MBD and the appropriate phosphate binder uses. Therefore, application of the MTC is anticipated to enhance quality of clinical care in chronic diseases.