Universal CKD care programs in Taiwan reduced incidence of maintenance dialysis
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Implementation of universal chronic kidney disease care programs in Taiwan significantly lowered long-term trends in the incidence of maintenance dialysis.
“In 2006, Taiwan National Health Insurance launched a pay-for-performance scheme with indicators for early CKD to encourage nephrologists to cooperate with nurses and dietitians to provide comprehensive care on the basis of the National Kidney Foundation-Kidney Disease Outcomes Quality Initiative guidelines ... ,” Ming-Yen Lin, PhD, from the division of nephrology in the department of internal medicine at Kaohsiung Medical University Hospital in Taiwan, and colleagues wrote. They added. “To extend the preventive concept to an earlier stage and to specialists other than nephrologists, another care incentive program named Early-CKD Care was launched in 2011 ...”
In a retrospective population-based study, researchers aimed to explore how implementation of universal CKD care in Taiwan impacted long-term trends of the incidence of kidney failure. They examined patients who received dialysis for at least 90 days between 2002 and 2016 in Taiwan. Data were derived from the latest Annual Report of Kidney Disease in Taiwan by the Taiwan Data Renal Report System.
Using age, sex and calendar year, researchers measured temporal trends in the incidence, prevalence and mortality of patients on dialysis. Researchers utilized a generalized linear model to determine the estimated annual percentage change. Similarly, researchers used an age-period-cohort model to measure the association of CKD programs with changes in the incidence of maintenance dialysis.
Researchers identified 144,258 incident cases with a follow-up of 346 million person-years during the observed periods. Models revealed the estimated annual percentage change of the expected crude incidence rate was reduced by 0.41%. This change was noticed more in women and patients older than 70 years. However, it was slightly increased among patients older than 75 years.
Overall, the implementation of CKD care programs correlated with a net drift of –1.09% per year. Additionally, using years 2007 to 2011 as a reference, researchers observed a substantial linear reduction in the period rate ratio from 1.06 in the years 2022 to 2006 to 0.95 in the years 2012 to 2016.
“We assessed net trends of the incidence of kidney failure across the CKD care programs implemented and observed an almost 10% annual net reduction in the incidence rate of kidney failure from 2002 [to] 2016 in Taiwan before and after the national incentivized CKD care policies were implemented,” Lin and colleagues wrote. “Although the young population exhibited declining trends, the elderly population exhibited rising trends. Although CKD care affects kidney failure incidence rates with varying scales, CKD care and prevention should be prioritized by countries to reduce the growing numbers of kidney failure cases.”
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