Quality of prereferral care in patients with chronic renal insufficiency.
Quality of prereferral care in patients with chronic renal insufficiency.
复制标题
慢性肾功能不全患者的转诊前护理质量。
DOI：
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发表时间：
2002
影响因子：
13.2
通讯作者：
B. Kiberd
中科院分区：
文献类型：
--
作者：
David R. Cleveland;K. Jindal;D. Hirsch;B. Kiberd
背景
慢性肾功能不全（CRI）的适当护理包括血压和糖尿病控制，以及贫血、酸中毒和骨病的调查和管理。在转诊给肾病专家时，缺乏关于这些参数控制的数据。同样，早期转诊已在文献中强调，但很少有出版物研究目前的转诊模式。
方法
对1998年和1999年在加拿大哈利法克斯转诊至肾病学家的所有新门诊患者进行了单中心回顾性/前瞻性审查，以识别CRI患者（男性血清肌酐> 1.6 mg/dL [141 micromol/L]或女性>1.2 mg/dL [106 micromol/L]）。转诊前护理的质量是基于初次就诊的数据。
结果
在审查的1，050份图表中，411名患者符合研究标准。26%的患者患有糖尿病，18%的患者肾小球滤过率低于15 mL/min，只有24%的患者血压得到最佳控制（收缩压<130 mm Hg，舒张压<80 mm Hg）。只有44%的患者服用了血管紧张素转换酶抑制剂。患者平均服用1.9种抗高血压药物。21%的患者存在严重贫血（血红蛋白< 10 g/dL），仅35%的患者进行了适当的检查。在19%的患者中发现钙水平低于8.6 mg/dL（2.15 mmol/L），这些患者中只有14%开始补钙治疗。在20%的患者中观察到磷酸盐水平大于5.0 mg/dL（1.6 mmol/L），其中14%的患者接受磷酸盐结合剂治疗。18%的患者甲状旁腺激素水平超过正常值的5倍，25%的患者碳酸氢盐水平低于23 mmol/L。
结论
一个显着比例的病人转介CRI得到不充分的转诊前护理。继续教育计划和转诊指南不仅要强调早期转诊的重要性，还要解决CRI的相关后果，以延缓肾脏疾病的进展并避免并发症。
BACKGROUND
Appropriate care in chronic renal insufficiency (CRI) includes blood pressure and diabetes control, as well as the investigation and management of anemia, acidosis, and bone disease. There is a lack of data on the control of these parameters at the time of referral to a nephrologist. Similarly, early referral has been emphasized in the literature, yet very little published has examined current referral patterns.
METHODS
A single-center retrospective/prospective review of all new outpatient referrals to nephrologists in Halifax, Canada, in 1998 and 1999 was conducted to identify patients with CRI (serum creatinine > 1.6 mg/dL [141 micromol/L] for men or >1.2 mg/dL [106 micromol/L] for women). Quality of prereferral care was based on data from the initial clinic visit.
RESULTS
Of 1,050 charts reviewed, 411 patients met the study criteria. Twenty-six percent of patients had diabetes mellitus, 18% were referred with a calculated glomerular filtration rate less than 15 mL/min, and blood pressure was optimally controlled (<130 mm Hg systolic and <80 mm Hg diastolic) in only 24%. Only 44% of patients were administered an angiotensin-converting enzyme inhibitor. Patients were administered an average of 1.9 antihypertensive agents. Significant anemia (hemoglobin < 10 g/dL) was present in 21%, and appropriate investigations were performed in only 35% of these patients. Calcium levels less than 8.6 mg/dL (2.15 mmol/L) were found in 19% of patients, and only 14% of these patients were started on calcium supplement therapy. Phosphate levels greater than 5.0 mg/dL (1.6 mmol/L) were seen in 20% of patients, and 14% of these patients were on phosphate-binder therapy. Parathyroid hormone levels were more than five times normal values in 18% of patients, and 25% of patients had bicarbonate levels less than 23 mmol/L.
CONCLUSIONS
A significant proportion of patients referred with CRI receive inadequate prereferral care. Continuing education programs and referral guidelines must not only emphasize the importance of early referral, but also address the related consequences of CRI to delay the progression of renal disease and avoid complications.
影响因子：
158.5
作者：
LEWIS, EJ;HUNSICKER, LG;ROHDE, RD
通讯作者：
ROHDE, RD