Impact of Pre‐ESRD Management on Dialysis Outcomes: A Review
Impact of Pre‐ESRD Management on Dialysis Outcomes: A Review
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ESRD 前期管理对透析结果的影响：回顾
DOI：
10.1111/j.1525-139x.1998.tb00329.x
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发表时间：
1998
影响因子：
1.6
通讯作者：
J. Sondheimer
中科院分区：
文献类型：
--
作者：
S. A. Hood;J. Sondheimer
终末期肾病（ESRD）是全球范围内日益严重的公共卫生问题，在逐渐老龄化的人群中发病率不断增加。ESRD护理费用高昂，从这一点来看，已经引起了很多注意。在美国，治疗ESRD患者的年费用现在超过130亿美元，其中住院治疗占该金额的40%以上（1-3）。在过去的几年里，美国的注意力一直集中在降低ESRD患者的死亡率上，美国仍然是工业化世界中死亡率最高的国家之一。尽管人们越来越关注透析的充分性和患者的营养状况，但死亡率仍然很高。越来越多的人认识到，在ESRD发作前存在的因素可能预测透析的结果，并可能受到改善ESRD前护理的显著影响。这些疾病包括贫血、左心室肥大、甲状旁腺功能亢进和营养不良。有理由认为，安全延迟终末期肾病发作的措施对患者有益，任何减少发病前风险因素的干预措施也是如此。本综述将重点关注支持ESRD前管理影响透析发病率、死亡率和费用这一假设的证据。
End-stage renal disease (ESRD) is a growing public health problem worldwide, with an increasing incidence in a progressively aging population. ESRD care is costly, and has drawn much notice from that standpoint. The annual costs of treating patients with ESRD in the United States now exceeds $13 billion, with hospitalization accounting for over 40% of this amount (1-3). Much attention over the past few years has been directed toward reducing the mortality of ESRD patients in the United States, which remains among the highest in the industrialized world. Mortality has remained high despite growing attention to adequacy of dialysis and patients’ nutritional status. Factors present prior to the onset of ESRD that might predict the outcome on dialysis and that might be significantly impacted upon by improved pre-ESRD care are becoming increasingly recognized. These include anemia, left ventricular hypertrophy, hyperparathyroidism, and malnutrition. It stands to reason that measures that safely delay the onset of ESRD would be beneficial to patients, as would any intervention that would reduce premorbid risk factors. This review will focus on the evidence supporting the presumption that pre-ESRD management impacts upon the morbidity, mortality, and costs of dialysis.