【Abstract】Objective To analyze the influence of hierarchical and individualized management model on the incidence of end-point events in chronic kidney disease (CKD) patients at stage 4-5. Methods This was a retrospective cohort study that enrolled the hospitalized CKD patients at stage 4-5 but without renal replacement therapy (RRT) from Sept. 2014 to Dec. 2015 in the Department of Nephrology, Xinqiao Hospital of Army Medical University. They were divided into experimental group and control group based on whether they received the long-term regular follow-up in the CKD Management Center. Death and renal replacement therapy were compared between the two groups at December 2018. Results A total of 233 patients were enrolled

in this study, in which 91 were in experimental group and 142 were in control group. At the end of the study, 8 patients in experimental group and 11 patients in control group died (χ2＝0.081, P＝0.776); 36 patients in experimental group (kidney transplant, 2 patients; peritoneal dialysis, 3 patients; hemodialysis, 31 patients) and 76 patients in control group (kidney transplant, 9 patients; peritoneal dialysis, 6 patients; hemodialysis, 61 patients) treated with RRT (χ2＝4.330, P＝0.037); 7 patients in experimental group and 2 patients in control group used arteriovenous fistula for blood access at the beginning of hemodialysis (χ2＝8.677, P＝0.003). Conclusions The hierarchical and individualized management model can decrease the use of RRT and temporary catheterization for blood access in CKD patients at stage 4-5.