liu.seSearch for publications in DiVA
Change search
ReferencesLink to record
Permanent link

Direct link
A fixed protocol for outpatient clinic routines in the care of patients with severe renal failure
Kärnsjukhuset, Skövde, Sweden.
Ryhov, Jönköping, Sweden.
Östergötlands Läns Landsting, Local Health Care Services in East Östergötland, Department of Internal Medicine in Norrköping.
Höglandssjukhuset, Eksjö, Sweden.
Show others and affiliations
2013 (English)In: Renal failure, ISSN 0886-022X, E-ISSN 1525-6049, Vol. 35, no 6, 845-854 p.Article in journal (Refereed) Published
Abstract [en]


The primary aim of this study was to assess whether a fixed protocol, using a specially trained team, for intermediate follow-up to fulfillment of guideline targets is non-inferior to conventional follow-up in the care of uraemic patients. A secondary aim was to investigate possible impact on patient outcome.


The cohort comprised 424 patients from seven centers. Inclusion criteria were either serum creatinine exceeding 200 µmol/l or calculated clearance below 30 ml/min, representing CKD 4 or 5a. Six centers followed a standardized protocol (group 1). One center provided controls (group 2). The study design was prospective and interventional. The variables measured were blood hemoglobin, bicarbonate, calcium, phosphate, intact parathyroid hormone, albumin, renal function variables, blood pressure and RAAS blockade. The number of patients achieving the set goals was analyzed as a time trend to determine if the intervention resulted in an improvement.


At baseline, group 1 had significantly lower GFR and higher serum creatinine, calcium, phosphate, calcium × phosphate product and bicarbonate, lower mean arterial pressure (MAP), systolic blood pressures and less use of RAAS. During the intervention, group 1 improved in the direction of guidelines for blood hemoglobin, albumin, bicarbonate and MAP. Outcome of secondary endpoints gave a risk of death of 30% in both groups, while the risk of renal replacement therapy was higher in group 1.


However, the time to renal replacement therapy was significantly shorter in the intervention group, indicating that other variables than guideline achievements are important for the patient.

Place, publisher, year, edition, pages
Informa Healthcare, 2013. Vol. 35, no 6, 845-854 p.
Keyword [en]
Guideline targets; risk factors; progression; protocol; renal replacement therapy; survival; uraemia
National Category
Medical and Health Sciences
URN: urn:nbn:se:liu:diva-96501DOI: 10.3109/0886022X.2013.794661ISI: 000320197800011PubMedID: 23713629OAI: diva2:642810
Available from: 2013-08-23 Created: 2013-08-20 Last updated: 2013-12-02Bibliographically approved

Open Access in DiVA

No full text

Other links

Publisher's full textPubMed

Search in DiVA

By author/editor
Fernström, AndersAlmroth, GabrielHaarhaus, Mathias
By organisation
Department of Internal Medicine in NorrköpingNephrologyFaculty of Health SciencesDepartment of NephrologyNephrology
In the same journal
Renal failure
Medical and Health Sciences

Search outside of DiVA

GoogleGoogle Scholar
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

Altmetric score

Total: 157 hits
ReferencesLink to record
Permanent link

Direct link