Resource utilization among kidney transplant recipients
Resource utilization among kidney transplant recipients
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DOI：
10.1046/j.1523-1755.2003.00102.x
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发表时间：
2003-08-01
影响因子：
19.6
通讯作者：
Pereira, BJG
中科院分区：
文献类型：
--
作者：
Khan, S;Tighiouart, H;Pereira, BJG
背景。住院治疗消耗了终末期肾病（ESRD）项目的很大一部分，其中包括肾移植受者。鉴别肾移植受者资源利用率增加的风险，可以采取适当的干预措施，以减轻肾移植相关的并发症，从而降低资源利用率。本研究对肾移植受者进行回顾性队列研究，以确定住院的危险因素。研究人群包括1990年10月至1999年9月在本中心接受肾移植的患者，并在门诊进行随访。在220例患者中，171例（78%）在中位随访36个月期间住院。每名患者每年的住院次数、住院天数和门诊次数分别为1.1、6.3和21.6。感染是住院的主要原因。在一项多因素回归分析中，供体巨细胞病毒（CMV）阳性状态（RR 1.58; 95% CI 1.15, 2.18）和移植住院期间较高的住院天数（RR 1.10 / 7天增加；95% CI 1.03, 1.19）与较高的住院风险相关，而较高的血清白蛋白（RR 0.84 / 0.5g/dL增加；95% CI 0.73, 0.97）、较高的红细胞压积(RR 0.95 / 1%增加；95% CI 0.92, 0.98)，较高的肾小球滤过率（GFR） （RR 0.91 / 10 mL/min/1.73 m）；95% CI 0.85, 0.99)和移植后间隔时间的增加（每6个月增加RR 0.84; 95% CI 0.75, 0.93）与住院风险降低相关。供体cmv阳性状态（RR 1.11, 95% CI 1.00, 1.21）和存在心血管疾病（RR1.12, 95% CI 1.00, 1.24）与门诊就诊的高风险相关，而白种人（RR 0.82, 95% CI 0.73, 0.94）、较高的血清白蛋白（RR 0.88, 95% CI 0.84, 0.93）、较高的红细胞压比（RR 0.96, 95% CI 0.95, 0.97）和移植后间隔时间增加(RR 0.79，每6个月增加；95% CI 0.76, 0.83)与较低的门诊就诊风险相关。识别与肾移植受者资源利用率增加相关的危险因素有助于制定有针对性的干预措施，以改善临床和经济结果。
Background. Hospitalization consumes a significant portion of the end-stage renal disease (ESRD) program, which includes kidney transplant recipients. Identification of kidney transplant recipients at risk of increased resource utilization could lead to appropriate interventions to attenuate the complications related to kidney transplant, which may reduce resource utilization.Methods. This retrospective cohort study of kidney transplant recipients was performed to identify risk factors for hospital utilization. The study population consisted of patients who received kidney transplant at our center between October 1990 and September 1999 and were followed in the outpatient clinic.Results. Of the 220 patients, 171 (78%) were hospitalized during a median follow-up of 36 months. The number of hospitalizations, hospital days, and outpatient visits per patient-year at risk were 1.1, 6.3, and 21.6, respectively. Infection episodes were the leading cause of hospitalization. In a multivariate regression analysis, cytomegalovirus (CMV)-positive status of donor (RR 1.58; 95% CI 1.15, 2.18) and a higher number of hospital days during the transplant hospitalization (RR 1.10 per 7 days increase; 95% CI 1.03, 1.19) were associated with a higher risk of hospitalization, while higher serum albumin (RR 0.84 per 0.5g/dL increase; 95% CI 0.73, 0.97), higher hematocrit (RR 0.95 per 1% increase; 95% CI 0.92, 0.98), higher glomerular filtration rate (GFR) (RR 0.91 per 10 mL/min/1.73 m(2) ; 95% CI 0.85, 0.99), and an increased interval since transplant (RR 0.84 per 6 months increase; 95% CI 0.75, 0.93) were associated with a lower risk of hospitalization. CMV-positive status of the donor (RR 1.11; 95% CI 1.00, 1.21) and presence of cardiovascular disease (RR1.12; 95% CI 1.00, 1.24) were associated with a higher risk of outpatient visits, while Caucasian race (RR 0.82; 95% CI 0.73, 0.94), higher serum albumin (RR 0.88 per 0.5 g/dL increase; 95% CI 0.84, 0.93), higher hematocrit (RR 0.96 per 1% increase; 95% CI 0.95, 0.97), and an increased interval since transplant (RR 0.79 per 6 months increase; 95% CI 0.76, 0.83) were associated with a lower risk of outpatient visits.Conclusion. Identification of risk factors associated with increase resource utilization among kidney transplant recipients could aid in the development of targeted interventions to improve clinical and economic outcomes.