Receipt of Nephrology Care and Clinical Outcomes Among Veterans With Advanced CKD.
Receipt of Nephrology Care and Clinical Outcomes Among Veterans With Advanced CKD.
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DOI：
10.1053/j.ajkd.2017.06.025
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发表时间：
2017-11
期刊：
影响因子：
--
通讯作者：
Kurella Tamura M
中科院分区：
文献类型：
--
作者：
Fung E;Chang TI;Chertow GM;Thomas IC;Asch SM;Kurella Tamura M
临床实践指南建议，一旦估计的肾小球滤过率（eGFR）福尔斯低于30 ml/min/1.73 m2，应转诊至肾脏科;然而，肾脏科治疗获益的证据不一。使用界标分析的观察性队列。一个患有晚期CKD的退伍军人的国家队列，定义为2010年1月1日至2010年12月31日门诊eGFR ≤30 ml/min/1.73m2，既往eGFR <60 ml/min/1.73m2，使用退伍军人事务部和美国肾脏数据系统的管理和实验室数据。12个月内接受门诊肾病治疗的次数和频率。生存率和进展为ESRD（接受透析或肾移植）是主要结局。此外，12个月内相关临床参数的控制是中间结局。在纳入队列的39，669例患者中，14，983例（37.8%）接受了肾脏护理。老年、心力衰竭、痴呆、抑郁和肾功能快速下降与缺乏肾脏病护理独立相关。在平均2.9年的随访中，14，719例（37.1%）患者死亡，4，310例（10.9%）进展为ESRD。在调整人口统计学、合并症和肾功能轨迹的模型中，肾病治疗与较低的死亡风险相关（HR，0.88; 95% CI，0.85-0.91），但与较高的ESRD风险相关（HR，1.48; 95% CI，1.38-1.58）。在入组时临床参数超出指南建议的患者中，与未接受肾脏护理的患者相比，接受肾脏护理的患者中血红蛋白、钾、白蛋白、钙和磷控制改善的校正比例显著更高。可能不适用于非退伍军人。在晚期CKD患者中，肾病护理与死亡率降低相关，但与进展为ESRD的风险降低无关。
Clinical practice guidelines recommend referral to nephrology once estimated glomerular filtration rate (eGFR) falls below 30 ml/min/1.73 m2; however, evidence for benefits of nephrology care are mixed. Observational cohort using landmark analysis. A national cohort of veterans with advanced CKD, defined by an outpatient eGFR ≤30 ml/min/1.73m2 for January 1, 2010 through December 31, 2010 and a prior eGFR <60 ml/min/1.73m2, using administrative and laboratory data from the Department of Veterans Affairs and the US Renal Data System. Receipt and frequency of outpatient nephrology care over 12 months. Survival and progression to ESRD (receipt of dialysis or kidney transplantation) were the primary outcomes. In addition, control of associated clinical parameters over 12 months were intermediate outcomes. Of 39,669 patients included in the cohort, 14,983 (37.8%) received nephrology care. Older age, heart failure, dementia, depression, and rapidly declining kidney function were independently associated with the absence of nephrology care. Over a mean follow up of 2.9 years, 14,719 (37.1%) patients died and 4,310 (10.9%) progressed to ESRD. In models adjusting for demographics, comorbidities, and trajectory of kidney function, nephrology care was associated with a lower risk of death (HR, 0.88; 95% CI, 0.85-0.91), but a higher risk of ESRD (HR, 1.48; 95% CI, 1.38-1.58). Among patients with clinical parameters outside of guideline recommendations at cohort entry, a significantly higher adjusted proportion of patients who received nephrology care had improvement in control of hemoglobin, potassium, albumin, calcium and phosphorus compared to those who did not receive nephrology care. May not be generalizable to non-veterans. Among patients with advanced CKD, nephrology care was associated with lower mortality, but was not associated with a lower risk for progression to ESRD.
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影响因子：
6.2
作者：
Alawadi Z;Phatak UR;Hu CY;Bailey CE;You YN;Kao LS;Massarweh NN;Feig BW;Rodriguez-Bigas MA;Skibber JM;Chang GJ
通讯作者：
Chang GJ
影响因子：
39.2
作者：
Kinchen, KS;Sadler, J;Powe, NR
通讯作者：
Powe, NR
影响因子：
13.2
作者：
Roubicek, C;Brunet, P;Berland, Y
通讯作者：
Berland, Y
DOI：
10.1038/ki.2009.188
发表时间：
2009-08-01
期刊：
Kidney international. Supplement
影响因子：
--
作者：
通讯作者：
--
DOI：
10.1682/jrrd.2009.08.0122
发表时间：
2010-01-01
影响因子：
--
作者：
Stroupe, Kevin T.;Tarlov, Elizabeth;Hynes, Denise M.
通讯作者：
Hynes, Denise M.