Design and methods of a strategic outcome study for chronic kidney disease: Frontier of Renal Outcome Modifications in Japan
Design and methods of a strategic outcome study for chronic kidney disease: Frontier of Renal Outcome Modifications in Japan
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DOI：
10.1007/s10157-009-0249-4
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发表时间：
2010-04
影响因子：
2.3
通讯作者：
K. Yamagata;H. Makino;T. Akizawa;K. Iseki;Sadayoshi Itoh;K. Kimura;D. Koya;I. Narita;T. Mitarai;M. Miyazaki;Y. Tsubakihara;Tsuyoshi Watanabe;T. Wada;O. Sakai;Advisory Committee for FROM-J
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文献类型：
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作者：
K. Yamagata;H. Makino;T. Akizawa;K. Iseki;Sadayoshi Itoh;K. Kimura;D. Koya;I. Narita;T. Mitarai;M. Miyazaki;Y. Tsubakihara;Tsuyoshi Watanabe;T. Wada;O. Sakai;Advisory Committee for FROM-J
背景在日本和其他国家，需要透析的人数的持续增加是一个重大的临床和社会经济问题。本研究旨在鼓励慢性肾脏病(CKD)患者就诊，加强肾脏科医生与全科医生之间的合作，防止肾脏疾病的进展。方法研究对象包括40~74岁的CKD患者就诊全科医生，以及CKD三期合并蛋白尿和糖尿病或高血压患者。本试验为分层开放整群随机研究，分为A组(弱干预)和B组(强干预)两个干预组。我们招募了15个不同地区的49个地方医学会(群)，根据透析患者增长率的水平将其划分为四个地区(阶层)。A组联网的患者最初被指导按照当前的CKD治疗指南进行治疗，而B组联网的患者不仅以同样的方式接受指导，而且还得到了基于信息技术(IT)的系统的支持，该系统旨在帮助实现CKD治疗、咨询支持中心和访问当地全科诊所的营养师咨询的目标。我们评估了CKD的持续会诊率、全科医生和肾脏科医生之间的协作以及CKD的进展(以CKD分期表示)。结论通过本研究，通过促进有效的沟通和对全科医生和肾脏科医生的支持来填补证据-实践空白，我们将建立CKD护理体系，减少晚期CKD患者的数量。
BackgroundThe continuous increase in the number of people requiring dialysis is a major clinical and socioeconomical issue in Japan and other countries. This study was designed to encourage chronic kidney disease (CKD) patients to consult a physician, enhance cooperation between nephrologists and general practices, and prevent the progression of kidney disease.MethodsSubjects comprise CKD patients aged between 40 and 74 years consulting a general physician, and patients in CKD stage 3 with proteinuria and diabetes or hypertension. This trial is a stratified open cluster-randomized study with two intervention groups: group A (weak intervention) and group B (strong intervention). We have recruited 49 local medical associations (clusters) in 15 different prefectures, which were classified into four regions (strata) based on the level of increase rate of dialysis patients. The patients in group A clusters were instructed initially to undergo treatment in accordance with the current CKD treatment guide, whereas patients in group B clusters were not only instructed in the same fashion but also received support from an information technology (IT)-based system designed to help achieve the goals of CKD treatment, consultation support centers, and consultations by dietitians visiting the local general practice offices. We assessed the rates of continued consultation, collaboration between general practitioners and nephrologists, and progression of CKD (as expressed by CKD stage).ConclusionThrough this study, filling the evidence-practice gap by facilitating effective communication and supporting general physicians and nephrologists, we will establish a CKD care system and decrease the number of advanced-stage CKD patients.