Late referral and modality choice in end-stage renal disease.
Late referral and modality choice in end-stage renal disease.
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终末期肾病的晚期转诊和治疗方式选择。
DOI：
10.1046/j.1523-1755.2001.00958.x
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发表时间：
2001
影响因子：
19.6
通讯作者：
Avorn,J
中科院分区：
文献类型：
--
作者：
Winkelmayer,WC;Glynn,RJ;Levin,R;OwenJr,W;Avorn,J
晚期肾病患者的晚期转诊和治疗方式选择。BackgroundWe试图确定慢性肾病患者晚期与早期转诊是否会影响血液透析（HD）与腹膜透析（PD）的初始选择或在治疗的前六个月内转换治疗方式的可能性。确定了在1991年1月至1996年6月期间开始RRT并且在RRT前一年以上诊断为肾病的所有患者。结果在控制了人口统计学特征、社会经济地位和基础肾脏疾病、年龄、黑人种族[比值比（OR）= 0.56]、黑人或白色以外的种族后，（OR = 0.56）和社会经济地位（OR = 0.68）影响初始治疗方式的选择，但转诊时间不影响。然而，较晚转诊开始PD治疗的患者转为HD的可能性比较早就诊于肾病科医生的患者高50%[危险比（HR）= 1.47]。在最初的HD患者中，糖尿病肾病（HR = 1.49）和黑人（HR = 0.69）影响了转换为PD的可能性，但转诊的时间并没有.ConclusionsThese结果反驳早期的研究结果，晚转诊可能会限制PD的访问。我们发现，治疗方式的选择取决于年龄、种族或社会经济地位等因素，而不是取决于肾病专家转诊的时间。延迟转诊不会影响开始HD的患者转换模式的可能性，但会影响开始PD的患者。
Late referral and modality choice in end-stage renal disease.BackgroundWe sought to determine whether late versus early referral to a nephrologist in patients with chronic kidney disease influences the initial choice of hemodialysis (HD) versus peritoneal dialysis (PD) or the likelihood of switching treatment modalities in the first six months of therapy.MethodsUsing New Jersey Medicare/Medicaid claims, all patients who started RRT between January 1991 and June 1996 and were diagnosed with renal disease more than one year prior to RRT were identified. In the resulting cohort of 3014 patients, 35% had their first nephrologist consultation ≤90 days prior to initiation of dialysis.ResultsAfter controlling for demographic characteristics, socioeconomic status and underlying renal disease, age, black race [Odds ratio (OR) = 0.56], race other than black or white (OR = 0.56), and socioeconomic status (OR = 0.68) influenced the choice of initial treatment modality, but timing of the referral did not. However, patients starting on PD who were referred late were 50% more likely to switch to HD than were patients who saw a nephrologist earlier [Hazard's ratio (HR) = 1.47]. In patients originally on HD, diabetic nephropathy (HR = 1.49) and black race (HR = 0.69) influenced the likelihood of switching to PD, but the timing of referral did not.ConclusionsThese results refute earlier findings that late referral may limit access to PD. We found that modality choice depends on factors such as age, race, or socioeconomic status, rather than on than timing of nephrologist referral. Late referral does not influence the likelihood to switch modality in patients starting on HD, but does so in patients starting on PD.