The impact of self-management support on the progression of chronic kidney disease-a prospective randomized controlled trial
The impact of self-management support on the progression of chronic kidney disease-a prospective randomized controlled trial
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DOI：
10.1093/ndt/gfr047
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发表时间：
2011-11-01
影响因子：
6.1
通讯作者：
Wu, Mai-Szu
中科院分区：
文献类型：
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作者：
Chen, Sue-Hsien;Tsai, Yun-Fang;Wu, Mai-Szu
背景慢性肾脏病（CKD）是一个全球性的公共卫生问题。多学科干预有助于改善CKD患者的预后。我们进行了一项开放标签、随机对照试验，以研究自我管理支持（SMS）对晚期CKD患者结局的影响。将偶发CKD（III-V期）患者随机分为自我管理支持（SMS）组和非SMS组，并随访12个月。短信包括健康信息、患者教育、电话支持和支持小组的帮助。主要终点是绝对估计肾小球滤过率（eGFR）的改变和住院事件的数量。次要终点为eGFR降低50%、终末期肾病（ESRD）需要肾脏替代治疗（RRT）、全因死亡率或复合次要终点。该研究纳入了54名患者; 27名患者被随机分配到SMS组，相同数量的患者被随机分配到非SMS组。研究结束时，SMS患者的绝对eGFR显著高于非SMS组（29.11 +/- 20.61 vs 15.72 +/- 10.67 mL/min; P < 0.05）。SMS组住院事件发生率低于非SMS组[5例（18.50%）比12例（44.47%）; P < 0.05]。SMS组1例患者（3.7%）和非SMS组9例患者（33.3%）eGFR降低>50%（P < 0.05）。然而，对需要RRT的ESRD复合次要终点和全因死亡率的生存分析显示，两组之间无差异。我们的随机研究表明，标准化的SMS程序可能在减少CKD进展和晚期CKD患者的发病率方面发挥重要作用。
Background. Chronic kidney disease (CKD) is a public health problem worldwide. Multidisciplinary intervention helps improve outcomes for CKD patients. We conducted an open-label, randomized controlled trial to examine the impact of self-management support (SMS) in the outcome of late-stage CKD patients.Methods. Incidental CKD (Stages III-V) patients were randomized into self-management support (SMS) and non-SMS groups and followed up for 12 months. SMS comprised health information, patient education, telephone-based support and the aid of a support group. The primary end points were absolute estimated glomerular filtration rate (eGFR) alteration and number of hospitalization events. The secondary end points were an eGFR decrease of up to 50%, end-stage renal disease (ESRD) demanding renal replacement therapy (RRT), all-cause mortality or a composite secondary end point.Results. The study included 54 patients; 27 patients were randomized into an SMS group and the same number into a non-SMS group. The absolute eGFR at the end of the study was significantly higher in SMS patients than in the non-SMS group (29.11 +/- 20.61 versus 15.72 +/- 10.67 mL/min; P < 0.05). There were fewer hospitalization events for SMS patients than for non-SMS patients [5 (18.50%) versus 12 (44.47%); P < 0.05]. One patient (3.7%) in the SMS group and nine (33.3%) in the non-SMS group had an eGFR reduction of >50% (P < 0.05). However, survival analysis of the composite secondary end points of ESRD that required RRT and all-cause mortality revealed no differences between the two groups.Conclusions. Our randomized study suggests that a standardized SMS program may play a significant role in reducing CKD progression and morbidity of late-stage CKD patients.