4 vs 15.5 days) at dialysis initiation were higher in the usual care group. Estimated medical costs during 3 months before dialysis till dialysis initiation, the MDC group yielded a reduction of NT$ 59 251 for each patient (P < 0.001). Patient mortality was not significantly different. Multidisciplinary care intervention for pre-ESRD patients could not only significantly improve the quality of disease care and clinical outcome, but also reduce medical costs. "
“Date written: December 2008 Final submission: March 2009 No recommendations possible Rapamycin nmr based on Level I or II evidence (Suggestions

are based on Level III and IV evidence) Registry data and data from observational cohort studies suggest that coexisting vascular disease, whether it be coronary artery disease (CAD), peripheral vascular disease (PVD) or cerebrovascular disease is associated with learn more increased mortality risk for patients on dialysis. Limited studies have addressed the effect of different levels of disease severity. Dialysis itself is associated with a significantly increased risk of worsening vascular disease and nephrologists should consider these factors when a decision is being made to commence dialysis and the patient

should be adequately informed regarding the outcomes in people with these comorbidities. No recommendation. Databases searched: MeSH terms and text words for cardiovascular disease, coronary disease and myocardial ischaemia were combined with MeSH

terms and text words for renal replacement therapy and dialysis. The search was carried out in Medline (1950–March, Week 3, 2008). The Cochrane Renal Group Trials Register was also searched for trials not indexed in Medline. Date of search/es: 2 April 2008. Patients with end-stage kidney disease (ESKD) are at high risk of developing cardiovascular disease (CVD), which is considered the leading cause of mortality and morbidity in dialysis patients, accounting for 40–50% of deaths.1 Although there have only been a few studies of CVD in a population with mild renal insufficiency, several authors have reported CYTH4 an elevated prevalence of CVD in patients starting dialysis compared with the general population.2–5 On admission to dialysis, patients have a high prevalence of cardiovascular risk factors. According to the Lombardy registry,6 it was estimated that 17.4% of the incident patients admitted to dialysis have CAD (9.8%) or myocardial infarction (7.6%). Congestive cardiac failure (CCF) was reported in the same study to be 8.3%. In the United States Renal Data System Registry (USRDS),7 the prevalence of CVD in incident ESKD patients should be proportionally higher, as there is a higher proportion of diabetics, however, the proportion of patients affected by ischaemic heart disease is 3 times higher (40.0%) and the proportion of patients affected by CCF is 5 times higher at 36.0%.