Insights From the 2016 Peer Kidney Care Initiative Report: Still a Ways to Go to Improve Care for Dialysis Patients
Insights From the 2016 Peer Kidney Care Initiative Report: Still a Ways to Go to Improve Care for Dialysis Patients
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DOI：
10.1053/j.ajkd.2017.08.023
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发表时间：
2018-01-01
影响因子：
13.2
通讯作者：
Collins, Allan J.
中科院分区：
文献类型：
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作者：
Wetmore, James B.;Li, Suying;Collins, Allan J.
尽管在过去十年中，接受维持性透析的患者的结果有所改善，但正如2016年同行肾脏护理倡议报告所强调的那样，在某些关键领域取得的进展很少。成人开始透析治疗的总体发病率保持相对稳定(类似于2009-2013年每10万美国人口中有42例)，但不同美国地理区域的发病率差异超过2倍，从26例到54例。突发事件患者的住院率从2003年的每百人年261次住院率下降到2012年的207次，但观察住院率从40次增加到67次，使住院人数的下降幅度减少了一半。因心力衰竭住院的患者普遍减少，从2004年的每100人年15.6人减少到2013年的9.5人，但因容量过重而住院的人数增加，从2004年的3.0人增加到2013年的6.1人，部分抵消了这一下降。在过去十年中，因心律失常住院的普遍患者比率(类似于每100人年4.6人)没有改善，而心脏性猝死占心血管死亡总数的比例从53%上升到73%。在此期间，肺炎/流感的住院率在流行患者中约为每100人年8.3人，而菌血症/败血症的住院率从8.6上升到12.0。如果死亡率要持续下降，就需要采取新的方法来应对这些挑战。
Although outcomes improved during the past decade for patients receiving maintenance dialysis, gains were few in certain key areas, as highlighted in the 2016 Peer Kidney Care Initiative Report. Overall incidence rates of dialysis therapy initiation in adults remained relatively stable (similar to 42 per 100,000 US population, 2009-2013), but rates varied more than 2-fold, from 26 to 54, across US geographic regions. Hospitalization rates in incident patients decreased from 261 hospitalizations per 100 patient-years in 2003 to 207 in 2012, but observation stay rates increased from 40 to 67, attenuating the decline in hospitalizations by half. Decreases in prevalent patient hospitalizations for heart failure, from 15.6 per 100 patient-years in 2004 to 9.5 in 2013, were partially offset by increases in hospitalizations for volume overload, from 3.0 in 2004 to 6.1 in 2013. Prevalent patient rates of hospitalizations for arrhythmias (similar to 4.6 per 100 patient-years) did not improve during the past decade, whereas sudden cardiac death as a proportion of total cardiovascular deaths increased from 53% to 73%. Hospitalization rates for pneumonia/influenza, at about 8.3 per 100 patient-years in prevalent patients, did not decrease during this period, while hospitalization rates for bacteremia/sepsis increased from 8.6 to 12.0. If decreases in mortality rates are to be sustained, novel approaches to these challenges will be required.