Abstract: 【Abstract】Objective To investigate the effect of multidisciplinary care (MDC) on renal outcome in CKD patients. Methods This is a prospective cohort study in a single center. Patients with CKD stage 1～5 without renal replacement treatments were followed up regularly in department of nephrology of the Second Hospital of Lanzhou University. Patients were divided into receiving MDC support (intervention group, IG) and physician care alone(control group,CG) according to their wishes. Clinical and laboratory data were collected． The primary renal endpoint is the diagnosis of ESRD and the secondary renal endpoint is 50% increase in serum creatinine. Results A total of 781 patients were enrolled in the final analysis, with 373 patients(92%) of IG and 408 patients (81%) of CG. After the enrollment of 2 years, eGFR decreasing were significantly slower in IG than that in CG(t2=- 2.606，P=0.009). Patients in the IG has a higher proportion of blood pressure≤130/80mmHg (c2=24.408, P＜0.001), a higher rate of serum Ca within 2.1～-2.5mmol/L (c2=4.630, P=0.031) and a higher rate of Hb level≥110g/L (c2=3.576, P=0.048). The MDC reduced the incidence of ESRD (HR,0.448; 95% CI, 0.306-0.656; P＜0.001). Subgroup analysis shown that men gender [HR,0.314 (0.188～0.524), P=0.018], without diabetes [HR, 0.649 (0.414～1.015), P=0.024] and CKD 1～3a group [HR, 0.015 (0.001～0.431), P= 0.031] had lower incident of ESRD. Conclusions MDC management can effectively delay the progress of CKD and improve the compliance rate of indicators.

Key words: CKD, Multidisciplinary Care, eGFR