1. A multifaceted intervention designed to improve medical management of moderate to advanced chronic kidney disease in HIV-infected patients: a cluster randomised trial
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P Brazille, Johan Chanal, N. de Castro, B. Lefebvre, Sophie Abgrall, N Petit, M Marcou, Pascal Pugliese, A Parrot, F Meier, Yazdan Yazdanpanah, A Signori-Schmuck, Hana Selinger-Leneman, Pierre Delobel, F Touam, A Cros, Claire Rouzaud, Philippe Bossi, J. P. Faller, Jean-Marc Mauboussin, Faiza Ajana, V Perronne, V Chambrin, Olivier Lortholary, Laurent Alric, V. Gendrin, C Sautron, K Benhadj, H Gil, C Lascoux, F Raffi, JE Kahn, Michel Vidal, J. J. Laurichesse, O Ruyer, F Brunel, Pascal Chavanet, J. Durant, J. M. Chapplain, T. Perpoint, D Blanc, S Casanova, Frédéric Méchaï, P Poubeau, M Benomar, David Zucman, P Fischer, H Fischer, V Ronat, D Coban, Elisabeth Rouveix, H. Berthé, E Roveix, Corinne Isnard-Bagnis, Aurélie Fillion, P Loulergue, Jennifer M. Rohan, Isabelle Ravaux, Catherine Michel, C Faudon, Jacques Gilquin, J. M. Livrozet, Christian Chidiac, G Wartel, Patricia Enel, G. Beck-Wirth, I Prade, O. Derradji, Jean-Paul Viard, Cécile Goujard, R Cohen Valensi, M Batard, Jean-Luc Meynard, G Camuset, Jacques Cadranel, Christian Pradier, S Gohier, Jean-François Bergmann, Francis Barin, D. Makhloufi, Philippe Gerhardt, A Canestri, Lionel Piroth, S Greffe, N Biezunski, C Bolliot, L Toko, G Mboungou, Jérôme Moreau, Valérie Potard, H Masson, Eric Rosenthal, Jacques Reynes, André Cabié, Gilles Pialoux, P Granet Brunello, F Durand, Véronique Obry-Roguet, Jade Ghosn, V Walter, P Gazalet, O Boulat, P M Girard, A Ménard, M. Môle, G Martin Blondel, M Hamidi, C Lupin, P Druart, Sophie Matheron, Catherine Chirouze, P. De Truchis, Laurent Cotte, P. Del Giudice, Caroline Dupont, Anne Frésard, C Jung, V Payssan, M Saidani, C. Chesnel, Véronique Joly, S Abgrall, B Wifaq, Bruno Hoen, I Fabre, E Pannier Metzger, M Beyrne, Christian Rabaud, C. Gaud, Pierre Durieux, S Makhloufi, Eric Billaud, Jean-Marc Lacombe, T Akpan, PY Dides, Dominique Mathez, V Delcey, P. Sellier, A Naqvi, Amanda Lopes, Laurent Hustache-Mathieu, C Bartoli, V Marcou, Murielle Mary-Krause, Elisabeth Botelho-Nevers, K Samar, Hervé Tissot-Dupont, M Ruquet, Laurence Weiss, Boue F, Philippe Morand, I Lamaury, L Meddeb, Nadia Valin, M Delestan, N. Jacquemet, N Méaux-Ruault, A Gergely, M. Blanc, M Sordage, L Sutton, Dominique Costagliola, V Thomas, PH Consigny, G Cessot, C Le Jeunne, A Freire Maresca, A Greder Belan, Jean-Pierre Morini, G Astier, D. Martin, Pierre-Marie Roger, E Bourzam, G Melica-Gregoire, Nicolas Vignier, B. Taverne, P. Leclercq, M. Sebire, A Adda, A Meybeck, MG Lebrette, André Boibieux, T. Allegre, Nicolas Dupin, M. Parrinello, S Roussin-Bretagne, Christine Jacomet, Laurence Gérard, Jean Deleuze, A S Ritleng, M Raho-Moussa, Marialuisa Partisani, Daniel Vittecoq, M André, Albert Sotto, Pierre Tattevin, S Marque Juillet, Antolini-Bouvenot, Sylvie Abel, M Guivarch, S Lang, P. Honoré, A Lavolé, C. Majerholc, Gilles Hittinger, Marguerite Guiguet, N Magy-Bertrand, Alain Lafeuillade, Elina Teicher, JM Riou, B Slama, Sophie Grabar, N. Viget, P Genet, Faouzi Souala, X. Duval, Lise Cuzin, B. Marchou, D Bonnabel, O. Faucher, S Stegmann, C Veyssier-Belot, I Perbost, K Bourdic, Cédric Arvieux, V Masse, L Pellissier, Giovanna Melica, S Lariven, S Chebrek, H Zerazhi, G Philip, Hugues Melliez, D Marigot-Outtandy, Mark Bloch, E Fourn, E. Billaud, J. Gerbe, C Dhiver, Benveniste O, Delphine Bonnet, D. Quinsat, V Daneluzzi, E Haustraete, P Guet, Dominique Salmon, Christophe Rioux, E Duvallon, E. Mortier, G Borgherini, P Goubin, D. Costagliola, Renaud Verdon, M J Soavi, A. Simon, F Zeng, Aba Mahamat, Mathieu Nacher, P Colardelle, F Granier, E Hope-Rapp, M. Poupard, V Vanticlke, M P Bouillon, C Clavel, Ml Lucas, P. Chiarello, Fabienne Caby, G Jacques, Juliette Pavie, MP Pietri, Blandine Denis, P. Miailhes, Sylvie Bregigeon, B Mouchet, Marie-Aude Khuong-Josses, P Thibaut, Antoine Rachas, H Laurichesse, Sylvie Dargere, C Godin Collet, Odile Launay, Jacques Gasnault, Clotilde Allavena, C. Dumont, Isabelle Poizot-Martin, M. Ratajczak, A. Maignan, A Brunon-Gagneux, Olivier Epaulard, A Therby, Tristan Ferry, E Reimann, Laurent Boyer, Régine Doncesco, Eric Cua, K Risso, Claudine Duvivier, Leila Adriouch, W. Rozenbaum, Christian Perronne, R Sambuc, I Kansau, J. F. Faucher, Florence Huber, J. M. Ruiz, Ma Khuong, Sandrine Pierre-François, Laurence Lievre, G Breton, J.-M. Molina, C. Tomei, M Guiguet, A Proust, L Fonquernie, D. Bornarel, David Rey, Isabelle Rouanet, C Guglielminotti, Jérôme Tourret, V. Reliquet, A Palacin, C Cheneau, Eric Oksenhendler, P Féret, B Montoya, V Lambry, N Hall, Jean-Daniel Lelièvre, Delphine Croisier, C Ricaud, M Ptak, Pierre Couppié, S Mokhtari, Y Welker, R Rodet, T May, Epidémiologie, stratégies thérapeutiques et virologie cliniques dans l'infection à VIH, Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Ecologie et Evolution des Microorganismes (EEM), Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre hospitalier universitaire de Nantes (CHU Nantes), Service des maladies infectieuses et réanimation médicale [Rennes] = Infectious Disease and Intensive Care [Rennes], CHU Pontchaillou [Rennes], Fonction, structure et inactivation d'ARN bactériens, Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Epidémiologie, Systèmes d'Information, Modélisation, Université Pierre et Marie Curie - Paris 6 (UPMC)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Centre de Recherche des Cordeliers (CRC (UMR_S 872)), Université Pierre et Marie Curie - Paris 6 (UPMC)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Institut National de la Santé et de la Recherche Médicale (INSERM), ANRS, 2009, the French Ministry of Health, Université Pierre et Marie Curie - Paris 6 ( UPMC ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Ecologie et Evolution des Microorganismes ( EEM ), Université Paris Diderot - Paris 7 ( UPD7 ) -Université Paris 13 ( UP13 ) -Université Sorbonne Paris Cité ( USPC ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Centre hospitalier universitaire de Nantes ( CHU Nantes ), Service des maladies infectieuses et réanimation médicale, Université de Rennes 1 ( UR1 ), Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -Hôpital Pontchaillou, Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Université Pierre et Marie Curie - Paris 6 ( UPMC ) -Assistance publique - Hôpitaux de Paris (AP-HP)-Institut National de la Santé et de la Recherche Médicale ( INSERM ) -CHU Pitié-Salpêtrière [APHP], Centre de Recherche des Cordeliers ( CRC (UMR_S 872) ), Université Pierre et Marie Curie - Paris 6 ( UPMC ) -Université Paris Descartes - Paris 5 ( UPD5 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Centre National de la Recherche Scientifique ( CNRS ), Université Paris Diderot - Paris 7 (UPD7)-Université Paris 13 (UP13)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Université Paris Descartes - Paris 5 (UPD5)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou, and Université Pierre et Marie Curie - Paris 6 (UPMC)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [APHP]
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Male ,Microbiology (medical) ,Nephrology ,medicine.medical_specialty ,HIV Infections ,urologic and male genital diseases ,law.invention ,Randomized controlled trial ,law ,[ SDV.MP ] Life Sciences [q-bio]/Microbiology and Parasitology ,Internal medicine ,Humans ,Medicine ,Cluster randomised controlled trial ,Aged ,business.industry ,Guideline ,Middle Aged ,medicine.disease ,HIV infection ,Confidence interval ,3. Good health ,clinical practice ,Clinical trial ,Treatment Outcome ,Infectious Diseases ,Blood pressure ,[SDV.MP]Life Sciences [q-bio]/Microbiology and Parasitology ,Practice Guidelines as Topic ,Physical therapy ,cluster randomized trial ,Kidney Failure, Chronic ,Female ,business ,chronic kidney disease ,Glomerular Filtration Rate ,Kidney disease - Abstract
International audience; Background - Chronic kidney disease (CKD) is frequent in individuals infected with human immunodeficiency virus (HIV). Progression to end-stage renal disease can be slowed by appropriate medical management. Methods - To assess whether active promotion of guidelines improves CKD management, we conducted a cluster randomized controlled trial within the French Hospital Database on HIV (FHDH-ANRS CO4). We randomized 46 centers participating in the FHDH to either simple information on guideline availability or active promotion with a multifaceted and repeated intervention comprising reminders and audit feedback and targeting of local opinion leaders carried out between April 2009 and April 2010. Outcome measure was CKD management adequacy assessed before and 2 years after the beginning of the intervention in HIV-infected patients with moderate to severe CKD. CKD management was considered adequate in case of referral to a nephrologist or if proteinuria, blood pressure, low-density lipoprotein cholesterol level, and glycemia had been measured during the previous year and medications had been prescribed when necessary. Results - Three hundred six patients were enrolled, of whom 238 (78%) completed the 2 years of follow-up. During the study period, the percentage of patients receiving adequate CKD management improved from 64.1% to 70.4% (+6.3%) in the active arm and from 68.3% to 75.6% (+7.3%) in the control arm (adjusted mean difference, -0.7 percentage points [95% confidence interval: -9.2 to 7.9]; P = .95). The biggest impact of active promotion was on the management of proteinuria and blood pressure. Conclusions - Adequate compliance with CKD management guidelines improved slightly between 2009 and 2011, with no difference between the simple information and active promotion arms. Clinical trials registration - CCTIRS 10.150 and CNIL DR-2010-379.
- Published
- 2015
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