An effective approach to the epidemic of chronic kidney disease: the health network

Abstract

An effective approach to the epidemic of chronic renal failure: a health network. The health network TIRCEL (multidisciplinary, that combines private and public medicine structures) is directed to patients with chronic kidney disease (CKD); it is located in the city of Lyon and adhered communities, of Rhone-Alpes Region, Francia. The net mission is to coordinate the detection, treatment and prevention of progression of CKD; to fulfill its mission, it is involved in actions directed to improve health professional formation, to inform the patients and the community, and to intervene in medícal and socio-economic research. The clinical data of all the adhered patients is computadorized, and can be accessed by the involved professional through Internet. After three years of running, a reduction in the speed of CKD's progression, as well as diastolic arterial pressure, and an increase in the levels of plasmatic hemoglobin (all statistically significant) were observed. Renal function (RF) stayed without modifications in 82% of the patients, deteriorated in 10% and improved in 8%. In patients in whorn, alleast, 4 determinations ofRF, estimated  through Cockroft & Gault formula, were done, the deterioration was - 3.47 mIlmin/year during the first 6 months, and - 0.13 ml/min/year alter 1 year of follow-up (p=0.026). A tendency to a reduction of proteinuria was observed too, as well as an increase in the number of patients that received drugs acting over the renin angiontensin axis. These facts confirmed the benefits obtained through patient's adhesion to a multidisciplinary health  net directed to the treatment of CKD.