Multidisciplinary Care Improves Outcome of Patients with Stage 5 Chronic Kidney Disease
Multidisciplinary Care Improves Outcome of Patients with Stage 5 Chronic Kidney Disease
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DOI：
10.1159/000313487
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发表时间：
2010-01-01
影响因子：
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通讯作者：
Dasgupta, Indranil
中科院分区：
文献类型：
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作者：
Fenton, Anthony;Sayar, Zara;Dasgupta, Indranil
背景和目的：多学科护理（MDC）是众所周知的，以改善慢性病的管理。在这项研究中，我们调查了MDC是否改善了晚期慢性肾脏病患者的预后。设计、设置、参与者和测量：在这项回顾性病例对照研究中，我们比较了MDC患者队列（n = 171）和肾病患者队列（n = 194）开始透析时及以后的结局。两组在人口统计学上匹配良好，在开始透析前至少3个月在诊所就诊。比较两组患者的透析通路、血压、血红蛋白、各种生化指标、住院率和生存率。结果：在MDC组中，68.4%的患者开始永久性通路透析，而肾病专家组为58.8%（p = 0.04）。MDC组的平均血红蛋白为10.28 +/- 1.86 g/dl，肾病组为9.81 +/- 1.76 g/dl（p = 0.02）。在血压控制或血清钙、磷酸盐或白蛋白水平方面，两组之间没有差异。MDC队列的住院率更低（每例患者每年1.42 vs 2.52例住院，p = 0.005）。Kaplan-Meier生存分析显示，MDC组的患者生存率显著更好（p = 0.033）。结论：这项研究表明，与参加传统肾脏科诊所的患者相比，参加多学科诊所的患者为透析治疗做了更好的准备，开始透析后住院人数更少，并且患者生存率更高。版权所有（C）2010 S. Karger AG，巴塞尔
Background and Objectives: Multidisciplinary care (MDC) is known to improve the management of chronic diseases. In this study, we investigated whether MDC improves outcomes in patients with advanced chronic kidney disease. Design, Setting, Participants and Measurements: In this retrospective case-control study we have compared the outcomes at the point of starting dialysis and beyond between a cohort of MDC patients (n = 171) and a cohort of nephrology patients (n = 194). The groups were well-matched demographically and were seen in the clinic for at least 3 months before starting dialysis. Dialysis access, blood pressure, haemoglobin, various biochemical parameters, hospital admissions, and survival were compared between the 2 groups. Results: In the MDC group, 68.4% started dialysis with permanent access compared with 58.8% in the nephrologist group (p = 0.04). The mean haemoglobin in the MDC group was 10.28 +/- 1.86 versus 9.81 +/- 1.76 g/dl in the nephrology group (p = 0.02). There was no difference between the groups in terms of blood pressure control or serum calcium, phosphate, or albumin levels. There were fewer hospital admissions in the MDC cohort (1.42 vs. 2.52 admissions per patient per year, p = 0.005). Kaplan-Meier survival analysis showed that patient survival was significantly better in the MDC group (p = 0.033). Conclusions: This study demonstrates that patients attending a multidisciplinary clinic are better prepared for dialysis treatment, have fewer hospital admissions after start of dialysis, and have a higher patient survival compared to those attending a traditional nephrology clinic. Copyright (C) 2010 S. Karger AG, Basel