Trends in timing of initiation of chronic dialysis in the United States.
Trends in timing of initiation of chronic dialysis in the United States.
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DOI：
10.1001/archinternmed.2011.436
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发表时间：
2011-10-10
影响因子：
--
通讯作者：
Larson EB
中科院分区：
文献类型：
--
作者：
O'Hare AM;Choi AI;Boscardin WJ;Clinton WL;Zawadzki I;Hebert PL;Kurella Tamura M;Taylor L;Larson EB
在过去的十年中，在美国观察到一种趋势，即在较高的估计肾小球滤过率水平下开始慢性透析。这可能反映了透析人群组成的长期趋势以及在肾病病程中更早开始透析的趋势。本研究的目的是对1997年至2007年期间透析开始时间的变化幅度进行基于模型的估计。我们使用来自终末期肾病国家登记处的信息，对1997年或2007年首次接受慢性透析治疗的患者开始时的估计肾小球滤过率进行了研究。我们使用了来自综合医疗保健系统的关于透析前肾小球滤过率斜率估计值的信息。在考虑了1997年至2007年美国新透析患者特征的变化后，我们估计，与前一年相比，后一年的慢性透析开始时间平均提前147天（95%置信区间，134-160）。在一系列患者亚组中，时间差异是一致的，但在75岁或以上的患者中最明显;该亚组中时间的平均差异为233天（95%置信区间，206-267）。与1997年相比，2007年肾病患者开始慢性透析的时间明显提前。在缺乏强有力的证据表明，早期开始慢性透析是有益的，这些研究结果要求仔细评估当代透析开始在美国的做法。
During the past decade, a trend has been observed in the United States toward initiation of chronic dialysis at higher levels of estimated glomerular filtration rate. This likely reflects secular trends in the composition of the dialysis population and a tendency toward initiation of dialysis earlier in the course of kidney disease. The goal of this study was to generate model-based estimates of the magnitude of changes in the timing of dialysis initiation between 1997 and 2007. We used information from a national registry for end-stage renal disease on estimated glomerular filtration rate at initiation among patients who received their first chronic dialysis treatment in 1997 or 2007. We used information regarding predialysis estimated glomerular filtration rate slope from an integrated health care system. After accounting for changes in the characteristics of new US dialysis patients from 1997 to 2007, we estimate that chronic dialysis was initiated a mean of 147 days earlier (95% confidence interval, 134–160) in the later compared with the earlier year. Differences in timing were consistent across a range of patient subgroups but were most pronounced for those aged 75 years or older; the mean difference in timing in that subgroup was 233 days (95% confidence interval, 206–267). Chronic dialysis appears to have been initiated substantially earlier in the course of kidney disease in 2007 compared with 1997. In the absence of strong evidence to suggest that earlier initiation of chronic dialysis is beneficial, these findings call for careful evaluation of contemporary dialysis initiation practices in the United States.
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