中国血液净化

中国血液净化 ›› 2021, Vol. 20 ›› Issue (02): 82-85.doi: 10.3969/j.issn.1671-4091.2021.02.003

• 临床研究 • 上一篇    下一篇

非透析慢性肾脏病患者的多学科医疗管理效果探讨

史书君1,王文革1,梁耀军1   

  1. 1兰州大学第二医院肾内科
  • 收稿日期:2020-06-30 修回日期:2020-10-12 出版日期:2021-02-12 发布日期:2021-02-23
  • 通讯作者: 王文革 lzwangwenge@163.com E-mail:lzwangwenge@163.com
  • 基金资助:
    甘肃省卫生行业科研计划管理项目(GWGL2013-37)

Effect Investigation of Non-dialysis CKD Patients with Multidisciplinary Care

  1. 1Department of Nephrolgy, The Second Hospital of Lanzhou University, Lanzhou, 730030, China
  • Received:2020-06-30 Revised:2020-10-12 Online:2021-02-12 Published:2021-02-23

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摘要： 【摘要】目的调查多学科医疗管理模式(multidisciplinary care，MDC)对慢性肾脏病(chronic kidney disease，CKD)非透析人群管理效果。方法采取前瞻性队列研究设计，选取兰州大学第二医院肾内科规律随访的CKD 非透析患者，根据患者意愿分为管理组和对照组。管理组通过MDC 管理，对照组采用传统模式管理，收集实验室指标，以进入终末期肾脏病(end stage renal disease，ESRD)、肌酐较基线水平升高超过50%作为本次研究的终点及次要终点事件完成统计分析。结果781 例患者完成研究，其中管理组373 例(92%)，对照组共408 例(81%)。2 年后，管理组估算肾小球滤过率(estimated glomerular filtration rate，eGFR)下降更缓慢(t= -2.606, P=0.009)。血压(＜130/80mmHg，c2=24.408，P＜0.001)、血钙(c2=4.630，P=0.031)达标率更高，血红蛋白≥110g/L 比例更高(c2=3.576，P=0.048)。管理组ESRD 的发生率降低(HR=0.448,95%CI 0.306～0.656,P＜0.001)，进行亚组分析，男性、非糖尿病CKD 人群、CKD1～3a 期人群ESRD 发生风险更低(HR 值分别为0.314，0.649，0.015；95%CI 分别为0.188～0.524，0.414～1.015，0.001～0.431；P 值分别为0.018，0.024，0.031)。结论MDC 可有效延缓CKD 进展、提高临床指标达标率。

关键词: 慢性肾脏病, 多学科医疗管理模式, eGFR

Abstract: 【Abstract】Objective To investigate the effect of multidisciplinary care (MDC) on renal outcome in CKD patients. Methods This is a prospective cohort study in a single center. Patients with CKD stage 1～5 without renal replacement treatments were followed up regularly in department of nephrology of the Second Hospital of Lanzhou University. Patients were divided into receiving MDC support (intervention group, IG) and physician care alone(control group,CG) according to their wishes. Clinical and laboratory data were collected． The primary renal endpoint is the diagnosis of ESRD and the secondary renal endpoint is 50% increase in serum creatinine. Results A total of 781 patients were enrolled in the final analysis, with 373 patients(92%) of IG and 408 patients (81%) of CG. After the enrollment of 2 years, eGFR decreasing were significantly slower in IG than that in CG(t2=- 2.606，P=0.009). Patients in the IG has a higher proportion of blood pressure≤130/80mmHg (c2=24.408, P＜0.001), a higher rate of serum Ca within 2.1～-2.5mmol/L (c2=4.630, P=0.031) and a higher rate of Hb level≥110g/L (c2=3.576, P=0.048). The MDC reduced the incidence of ESRD (HR,0.448; 95% CI, 0.306-0.656; P＜0.001). Subgroup analysis shown that men gender [HR,0.314 (0.188～0.524), P=0.018], without diabetes [HR, 0.649 (0.414～1.015), P=0.024] and CKD 1～3a group [HR, 0.015 (0.001～0.431), P= 0.031] had lower incident of ESRD. Conclusions MDC management can effectively delay the progress of CKD and improve the compliance rate of indicators.

Key words: CKD, Multidisciplinary Care, eGFR

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