Primary care-based disease management of chronic kidney disease (CKD), based on estimated glomerular filtration rate (eGFR) reporting, improves patient outcomes.
Primary care-based disease management of chronic kidney disease (CKD), based on estimated glomerular filtration rate (eGFR) reporting, improves patient outcomes.
复制标题
基于估计肾小球滤过率 (eGFR) 报告的慢性肾病 (CKD) 初级保健疾病管理可改善患者预后。
DOI：
10.1093/ndt/gfm857
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发表时间：
2007
期刊：
影响因子：
--
通讯作者：
D. Marcelli
中科院分区：
文献类型：
--
作者：
N. Richards;Kevin Harris;M. Whitfield;D. O'Donoghue;Robert Lewis;M. Mansell;Stephen G. Thomas;J. Townend;Mick Eames;D. Marcelli
背景
大多数慢性肾脏疾病(CKD)3-5期患者在初级保健范围内得到管理。我们描述了为CKD患者引入基于算法的初级保健疾病管理计划(DMP)对患者预后的影响，该计划基于使用估计肾小球滤过率(EGFR)报告的自动诊断。
方法
英国西林肯郡初级保健信托基金的223,287名CKD分期为4或5级的患者在2005年3月至2006年10月期间被纳入DMP。我们分析了针对临床目标的表现，观察了加入DMP前后肾功能的变化，以及达到血压控制和血脂异常临床目标的患者比例。
结果
483名慢性肾脏病4期或5期患者参加了该计划。在9个月后，与基线和9个月时达到目标的百分比值相比，以下参数有显著改善：总胆固醇4.2(3.45-5.0)mm ol/L比4.6(3.9-5.4)mm o l/L(P<；0.01)，75.0%比64.5%(P<；0.001)；低密度脂蛋白2.2(1.6-2.8)mm o l/L vs 2.5(1.9-3.2)mm o l/L(P<；0.01)，81.9%vs 69.2%(P<；0.05)；舒张压分别为71(65-79)mm Hg和76(69-84)mm Hg(P<；0.01)，分别为68.4%和90.3%(P<；0.01)。参加计划前9个月的EGFR中位数下降(四分位数范围)为3.69(1.49-7.46)毫升/分钟/1.73m(2)，而登记后12个月的中位数下降(-2.61-3.12)毫升/分钟/1.73m(2)(P<；0.001)。在参加该计划前的9个月中，有122名患者的EGFR下降，或=5ml/min/1.73m(2)，中位数为9.90(6.55-12.36)ml/min/1.73m(2)，而在登记后的12个月中，他们的EGFR下降的中位数为-1.7(-6.41-1.64)ml/min/1.73m(2)(P<；0.001)。在其余患者中，治疗前EGFR下降的中位数为1.92(0.41~3.23)ml/min/1.73m(2)，治疗后12个月下降的中位数为0.86(-1.03~3.53)ml/min/1.73m(2)(P=0.082)。
结论
这些数据表明，这种形式的慢性病管理是在英国识别和管理CKD患者的有效方法。心血管危险因素的改善和肾功能下降率的降低可能会对患者的健康产生重大好处，并应为卫生经济节省成本。
BACKGROUND
The majority of patients with chronic kidney disease (CKD) stages 3-5 are managed within primary care. We describe the effects, on patient outcomes, of the introduction of an algorithm-based, primary care disease management programme (DMP) for patients with CKD based on automated diagnosis using estimated glomerular filtration rate (eGFR) reporting.
METHODS
Patients within West Lincolnshire Primary Care Trust, UK, population 223, 287 with CKD stage 4 or 5 were enrolled within the DMP between March 2005 and October 2006. We have analysed the performance against clinical targets looking at a change in renal function prior to and following joining the DMP and the proportion of patients achieving clinical targets for blood pressure control and lipid abnormalities.
RESULTS
Four hundred and eighty-three patients with CKD stage 4 or 5 were enrolled in the programme. There were significant improvements in the following parameters, expressed as median values (interquartile range) after 9 months in the programme, compared to baseline and percentage values patients achieving target at 9 months: total cholesterol 4.2 (3.45-5.0) mmol/l versus 4.6 (3.9-5.4) mmol/l (P < 0.01), 75.0% versus 64.5% (P < 0.001); LDL 2.2 (1.6-2.8) mmol/l versus 2.5 (1.9-3.2) mmol/l (P < 0.01), 81.9% versus 69.2% (P < 0.05); systolic blood pressure 130 (125-145) mmHg versus 139 (124-154) mmHg (P < 0.05), 56.2% versus 37.1% (P < 0.05) and diastolic blood pressure 71 (65-79) mmHg versus 76 (69-84) mmHg (P < 0.01), 68.4% versus 90.3% (P < 0.01). The median fall (interquartile range) in eGFR in the 9 months prior to joining the programme was 3.69 (1.49-7.46) ml/min/1.73 m(2) compared to 0.32 (-2.61-3.12) ml/min/1.73 m(2) in the 12 months after enrolment (P < 0.001). One hundred and twenty-two patients experienced a fall in eGFR of > or = 5 ml/min/1.73 m(2), median 9.90 (6.55-12.36) ml/min/1.73 m(2) in the 9 months prior to joining the programme, whilst in the 12 months after enrolment, their median fall in eGFR was -1.70 (-6.41-1.64) ml/min/1.73 m(2) (P < 0.001). In the remaining patients, the median fall in eGFR was 1.92 (0.41-3.23) ml/min/1.73 m(2) prior to joining the programme and 0.86 (-1.03-3.53) ml/min/1.73 m(2) in the 12 months after enrolment (P = 0.082).
CONCLUSIONS
These data suggest that chronic disease management in this form is an effective method of identifying and managing patients with CKD within the UK. The improvement in cardiovascular risk factors and reduction in the rate of decline of renal function potentially have significant health benefits for the patients and should result in cost savings for the health economy.
影响因子：
13.2
作者：
Coresh, J;Astor, BC;Levey, AS
通讯作者：
Levey, AS
影响因子：
120.7
作者：
Wright, JT;Bakris, G;Rostand, SG
通讯作者：
Rostand, SG