@article{65e20f5d9e6d419ba34453e53a803c02,
title = "CKD Care Programs and Incident Kidney Failure: A Study of a National Disease Management Program in Taiwan",
abstract = "Rationale & Objective: Taiwan implemented national pay-for-performance programs for chronic kidney disease (CKD) care in 2006 and 2011; however, it is unknown whether this affected trends in maintenance dialysis. This study assessed the temporal trends in the incidence, prevalence, and mortality of individuals treated with maintenance dialysis from 2002-2016 in Taiwan. Study Design: Follow-up study using Taiwan Renal Disease System Databases. Setting & Participants: Participants who received dialysis for ≥90 days. Predictors: Age, sex, and calendar year. Outcomes: Incidence, prevalence of maintenance dialysis, or death, ascertained using the National Death Registry database. Analytical Approach: The estimated annual percentage change was assessed by a generalized linear model, and the association of the programs with changes in the incidence of maintenance dialysis was evaluated using an age-period-cohort model. Results: A total of 144,258 incident cases with a follow-up of 346 million person-years were analyzed during the observed periods. The estimated annual percentage change of the expected crude incidence rate was slightly reduced by 0.41% (95% CI, −1.06 to 0.24) and was more obvious in women and patients aged greater than 70 years; whereas, it was significantly increased in those aged greater than 75 years. After disentangling age and cohort effects, the implementation of the care programs was associated with an overall net drift of −1.09% (95% CI, −1.65 to −0.52) per year and a significant linear reduction in the period rate ratio from 1.06 (95% CI, 1.02-1.09) in the years 2002-2006 to 0.95 (95% CI, 0.92-0.98) in 2012-2016, using years 2007-2011 as reference. Limitations: The findings of the study may have limited inferences to other countries with different health care systems. Conclusions: The implementation of universal CKD care programs in Taiwan has significantly reduced the long-term trends in the incidence of maintenance dialysis; hence, devoting governmental resources to CKD care and prevention is advocated.",
keywords = "Chronic kidney disease care, dialysis duration, end-stage kidney disease, incidence, kidney failure, maintenance dialysis, mortality, prevalence, secular trends, universal care",
author = "Lin, {Ming Yen} and Chiu, {Yi Wen} and Hsu, {Yung Ho} and Wu, {Mai Szu} and Chang, {Jer Ming} and Hsu, {Chih Cheng} and Yang, {Chih Wei} and Yang, {Wu Chang} and Hwang, {Shang Jyh}",
note = "Funding Information: Ming-Yen Lin, PhD, Yi-Wen Chiu, MD, Yung-Ho Hsu, MD, Mai-Szu Wu, MD, Jer-Ming Chang, MD, PhD, Chih-Cheng Hsu, MD, DrPH, Chih-Wei Yang, MD, PhD, Wu-Chang Yang, MD, and Shang-Jyh Hwang, MD, Research area and study design: MYL, YHH, and YWC; data acquisition: MYL and CCH; statistical analysis: MYL, CCH, and YWC; methodology: MYL, YWC, CCH, CWY, JMC, and YCY; supervision or mentorship: MSW, CCH, CWY, YCY, JMC, and SJH. Each author contributed important intellectual content during manuscript drafting or revision and accepts accountability for the overall work by ensuring that questions pertaining to the accuracy or integrity of any portion of the work are appropriately investigated and resolved. This study was supported by grants from the Taiwan Ministry of Science and Technology (MOST: 105-2314-B-037-065-, 106-2314-B-002-253-, 107-2314-B-037-122- and 108-2314-B-037-110-), Kaohsiung Medical University Hospital (KMUH: 105-5R17 and 106-6R21), and Center for Big Data Research to MYL; National Health Research Institutes (NHRI-EX108-10505PI and NHRI-EX109-10717PI), Taiwan Ministry of Science and Technology (MOST: 104-2314-B-037-073-MY3, 107-2314-B-037-020-MY2, and 109-2314-B-037-107-MY2), and Kaohsiung Medical University Hospital (KMUH104-4R09, KMUH105-5R16) to SJH; and Ministry of Science and Technology (MOST: 103-2314-B-037-033- and 104-2314-B-037-054), Kaohsiung Medical University Hospital (KMUH:103-3R10 and 104-4R11) to YWC. The sponsors had no role in the study design, data collection and analysis, publication decision, and interpretation of data, writing the report, and the decision to submit the report for publication. The authors declare that they have no relevant financial interests. We thank the members of the Committee on Information & Renal Report System Development, Taiwan Society of Nephrology, Mr. Ming-Huang Lin, MSc, and Miss Hsiao-Ting Wu, MSc, for devoting their intelligence to data cleaning, analysis, and verification for the Annual Report on Kidney Disease in Taiwan. The authors also appreciate the technical support of the NCI APCWeb Tool by David P. Check, BSc. Some of the study results were presented in an abstract form at the November 22, 2019 Annual Meeting of Taiwan Society of Nephrology, and the Asia-Pacific AKI to/on CKD Summit-exploring the very beginning. Received August 18, 2021. Evaluated by 1 external peer reviewer, with direct editorial input by the Statistical Editor, an Associate Editor, and the Editor-in-Chief. Accepted in revised form March 13, 2022. Funding Information: This study was supported by grants from the Taiwan Ministry of Science and Technology (MOST: 105-2314-B-037-065-, 106-2314-B-002-253-, 107-2314-B-037-122- and 108-2314-B-037-110-), Kaohsiung Medical University Hospital (KMUH: 105-5R17 and 106-6R21), and Center for Big Data Research to MYL; National Health Research Institutes (NHRI-EX108-10505PI and NHRI-EX109-10717PI), Taiwan Ministry of Science and Technology (MOST: 104-2314-B-037-073-MY3, 107-2314-B-037-020-MY2, and 109-2314-B-037-107-MY2), and Kaohsiung Medical University Hospital (KMUH104-4R09, KMUH105-5R16) to SJH; and Ministry of Science and Technology (MOST: 103-2314-B-037-033- and 104-2314-B-037-054), Kaohsiung Medical University Hospital (KMUH:103-3R10 and 104-4R11) to YWC. The sponsors had no role in the study design, data collection and analysis, publication decision, and interpretation of data, writing the report, and the decision to submit the report for publication. Publisher Copyright: {\textcopyright} 2022 The Authors",
year = "2022",
month = jul,
doi = "10.1016/j.xkme.2022.100485",
language = "English",
volume = "4",
journal = "Kidney Medicine",
issn = "2590-0595",
publisher = "Elsevier Inc.",
number = "7",
}